Healthcare Provider Details

I. General information

NPI: 1801474440
Provider Name (Legal Business Name): APOLLO KANYONYI KABUKURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MINOR AVE STE 205
SEATTLE WA
98104-2113
US

IV. Provider business mailing address

1201 2ND AVE STE 1400
SEATTLE WA
98101-3039
US

V. Phone/Fax

Practice location:
  • Phone: 206-470-1800
  • Fax:
Mailing address:
  • Phone: 206-395-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61525192
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: