Healthcare Provider Details

I. General information

NPI: 1780316877
Provider Name (Legal Business Name): KIRRA MANDEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15870 1ST AVE S STE 101
BURIEN WA
98148-1301
US

IV. Provider business mailing address

29819 5TH AVE SW
FEDERAL WAY WA
98023-3516
US

V. Phone/Fax

Practice location:
  • Phone: 206-242-2501
  • Fax:
Mailing address:
  • Phone: 801-647-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61351644
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14267678
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: