1821122557 NPI number — H LEE KILBURN MD PS

Table of content: (NPI 1821122557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821122557 NPI number — H LEE KILBURN MD PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H LEE KILBURN MD PS
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:
1821122557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 8TH AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98033-5319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-822-4119
Provider Business Mailing Address Fax Number:
425-822-8034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 8TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033-5319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-822-4119
Provider Business Practice Location Address Fax Number:
425-822-8034
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOECKEL
Authorized Official First Name:
SHARLA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
206-715-0738

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  MD00009032 , 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: 1460401 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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