MEDICARE: DR. LUBA KIHICHAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD00016178	WA
2	207Q00000X	Family Medicine Physician	MD00016178	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080124614	OTHER	WA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2955KI	OTHER	WA	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	117516	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1447232384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUBA KIHICHAK MD

Provider Business Mailing Address
First Line	:	PO BOX 34036
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1036
Country	:	US
Telephone Number	:	425-899-3292
Fax Number	:	425-899-3269

Provider Business Practice Location Address
First Line	:	22850 NE 8TH ST
Second Line	:	SUITE 103
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7256
Country	:	US
Telephone Number	:	425-898-0305
Fax Number	:	425-898-8825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	02/16/2011

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Directions to “ DR. LUBA KIHICHAK MD” Practice Location

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