Healthcare Provider Details

I. General information

NPI: 1619806056
Provider Name (Legal Business Name): KYRYLO KIRIEIEV LCPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 SUNSET AVE
FERNDALE WA
98248-8913
US

IV. Provider business mailing address

1360 SUNSET AVE
FERNDALE WA
98248-8913
US

V. Phone/Fax

Practice location:
  • Phone: 360-384-1858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPROS.PS.70017093
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORTH.OI.70017092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: