Healthcare Provider Details

I. General information

NPI: 1821766197
Provider Name (Legal Business Name): KRITTIN JAY SUPAPANNACHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6781
  • Fax: 206-341-0163
Mailing address:
  • Phone: 206-223-6781
  • Fax: 206-341-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD70131024
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA190197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: