Healthcare Provider Details

I. General information

NPI: 1154411049
Provider Name (Legal Business Name): KENNETH WAYNE FELDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E YESLER WAY #100
SEATTLE WA
98122-5959
US

IV. Provider business mailing address

2101 EAST YESLER WAY #100
SEATTLE WA
98122
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-7248
  • Fax: 206-329-9764
Mailing address:
  • Phone: 206-987-7248
  • Fax: 206-329-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00011919
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: