Healthcare Provider Details

I. General information

NPI: 1578553053
Provider Name (Legal Business Name): ROBERT KENT KILLIAN MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE SUITE 712
SEATTLE WA
98104-3595
US

IV. Provider business mailing address

901 BOREN AVE SUITE 712
SEATTLE WA
98104-3595
US

V. Phone/Fax

Practice location:
  • Phone: 206-568-6320
  • Fax: 206-329-2092
Mailing address:
  • Phone: 206-568-6320
  • Fax: 206-329-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD00033951
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: