Healthcare Provider Details

I. General information

NPI: 1205766763
Provider Name (Legal Business Name): ALAN KO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE STE B400
EVERETT WA
98201-1665
US

IV. Provider business mailing address

1321 COLBY AVE STE B400
EVERETT WA
98201-1665
US

V. Phone/Fax

Practice location:
  • Phone: 425-297-5234
  • Fax: 425-297-5235
Mailing address:
  • Phone: 425-297-5234
  • Fax: 425-297-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61677917
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: