Healthcare Provider Details

I. General information

NPI: 1992807499
Provider Name (Legal Business Name): TATYANA KUTSY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 11/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 112TH AVE NE BUILD 4 D-160
BELLEVUE WA
98004-3752
US

IV. Provider business mailing address

8513 218TH ST SW
EDMONDS WA
98026-7859
US

V. Phone/Fax

Practice location:
  • Phone: 425-637-2340
  • Fax: 425-637-0036
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00032596
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: