WESTERN WASHINGTON MEDICAL GROUP, INC PS
NPI 1396413803
Psychiatry & Neurology - Psychiatry in Everett, WA

Q: What is Western Washington Medical Group, Inc Ps's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Active since August 31, 2021CLIA 50D2025751 · Waiver

12728 19TH AVE SE STE 300, EVERETT, WA 98208(425) 252-1116 Get Directions Write a Review

NPPES record last updated: August 31, 2021. Verified against the NPPES registry weekly; last sync: September 27, 2026.

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About Western Washington Medical Group, Inc Ps NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WESTERN WASHINGTON MEDICAL GROUP, INC PS (NPI 1396413803), doing business as Wwmg Department Of Psychiatry, is a healthcare organization registered as a psychiatry in Everett, Washington and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Kimberly Holstein, Director Corporate Compliance, as its authorized official.

NPPES Registry Identity

NPI1396413803

Entity TypeOrganization

Primary Taxonomy2084P0800X

Legal Business NameWESTERN WASHINGTON MEDICAL GROUP, INC PS

Location Address12728 19TH AVE SE STE 300Everett, WA 98208-6526

Mailing Address1728 W Marine View Dr Ste 110Everett, WA 98201-2094 · (425) 259-4041 · Fax (425) 252-6642

Phone(425) 252-1116

Organization SubpartNo

Authorized OfficialKimberly HolsteinDirector Corporate Compliance · (425) 259-4041

Enumeration DateAugust 31, 2021

NPPES CertifiedAugust 31, 2021

✔ NPI 1396413803 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

12728 19TH AVE SE STE 300, Everett, WA 98208

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Other Names 1

Doing Business AsWwmg Department Of Psychiatry

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2025751

Western Washington Medical Group - Clinical Research · Everett, WA

Active · expires Apr 4, 2028

CLIA Number50D2025751

Laboratory TypeCommunity Clinic

Certificate Effective DateApril 20, 2026

Certificate Expiration DateApril 4, 2028

Laboratory DirectorDavid A. Russian

Laboratory Phone(425) 225-2755

Laboratory LocationWestern Washington Medical Group - Clinical Research12728 19th Ave SE Ste 300, Everett, WA 98208

CLIA data matches this NPI record on: Address

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YA-LAN HUANG MD

Internal Medicine (Nephrology)