Healthcare Provider Details

I. General information

NPI: 1730739004
Provider Name (Legal Business Name): KIM HOA THI DAO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 S ORCAS ST
SEATTLE WA
98108-3066
US

IV. Provider business mailing address

2820 S ORCAS ST
SEATTLE WA
98108-3066
US

V. Phone/Fax

Practice location:
  • Phone: 206-252-6937
  • Fax: 206-743-3116
Mailing address:
  • Phone: 206-252-6937
  • Fax: 206-743-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60867144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: