Healthcare Provider Details

I. General information

NPI: 1750973525
Provider Name (Legal Business Name): KE'ALE W LOUIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 BEACON AVE S
SEATTLE WA
98108-1525
US

IV. Provider business mailing address

4705 BEACON AVE S
SEATTLE WA
98108-1525
US

V. Phone/Fax

Practice location:
  • Phone: 206-328-0412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61413714
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: