Healthcare Provider Details

I. General information

NPI: 1285747139
Provider Name (Legal Business Name): KIM S REIS D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE
EVERETT WA
98201-1665
US

IV. Provider business mailing address

16216 N MEADOWDALE RD
EDMONDS WA
98026-4928
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4042
  • Fax: 425-262-4051
Mailing address:
  • Phone: 206-434-0437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOP60322795
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberDO-454
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A7595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: