Healthcare Provider Details

I. General information

NPI: 1508129578
Provider Name (Legal Business Name): GIGI KAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 COLBY AVE
EVERETT WA
98201-4940
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5436
  • Fax:
Mailing address:
  • Phone: 425-304-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14460
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60324664
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: