Healthcare Provider Details

I. General information

NPI: 1083716617
Provider Name (Legal Business Name): LEAH NAOMI KIVIAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST C-212, BOX 356340
SEATTLE WA
98195-6340
US

IV. Provider business mailing address

1959 NE PACIFIC ST C-212, BOX 356340
SEATTLE WA
98195-6340
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-0065
  • Fax:
Mailing address:
  • Phone: 206-543-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD00048286
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00048286
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: