Healthcare Provider Details

I. General information

NPI: 1083364160
Provider Name (Legal Business Name): SHAYAR PATRICK KIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

IV. Provider business mailing address

11808 NORTHUP WAY STE W105
BELLEVUE WA
98005-1922
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-9480
  • Fax:
Mailing address:
  • Phone: 425-284-1545
  • Fax: 425-284-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.MD.70115514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: