1831110782 NPI number — RAZAN R AL-KUDSI MD

Table of content: (NPI 1831110782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831110782 NPI number — RAZAN R AL-KUDSI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAZAN R AL-KUDSI MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831110782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16259 SYLVESTER RD SW
Provider Second Line Business Mailing Address:
#401
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98166-3049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-242-8837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16259 SYLVESTER RD SW
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-8837
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AL KUDSI
Authorized Official First Name:
RAZAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-242-8837

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  MD00028577 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110061080 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1073238 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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