Healthcare Provider Details

I. General information

NPI: 1215115308
Provider Name (Legal Business Name): KELVIN K MA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 36TH AVE E
SEATTLE WA
98112-4429
US

IV. Provider business mailing address

1117 36TH AVE E
SEATTLE WA
98112-4429
US

V. Phone/Fax

Practice location:
  • Phone: 800-926-8273
  • Fax: 888-539-8781
Mailing address:
  • Phone: 253-740-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD00022157
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: