Healthcare Provider Details

I. General information

NPI: 1598732968
Provider Name (Legal Business Name): JEFFREY KYLLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BROADWAY
SEATTLE WA
98122-4201
US

IV. Provider business mailing address

1229 MADISON ST SUITE 1600
SEATTLE WA
98104-3586
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-1760
  • Fax:
Mailing address:
  • Phone: 206-343-3118
  • Fax: 206-860-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD00020413
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: