Healthcare Provider Details

I. General information

NPI: 1952044653
Provider Name (Legal Business Name): KAG C IGLINSKI-BENJAMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

IV. Provider business mailing address

2245 NW 56TH ST APT 637
SEATTLE WA
98107-4460
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-1711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61683519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: