Healthcare Provider Details

I. General information

NPI: 1902415888
Provider Name (Legal Business Name): ELAINE J KOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 TERRY AVE UNIT 423
SEATTLE WA
98104-2282
US

IV. Provider business mailing address

520 TERRY AVE UNIT 423
SEATTLE WA
98104-2282
US

V. Phone/Fax

Practice location:
  • Phone: 425-614-8719
  • Fax:
Mailing address:
  • Phone: 425-614-8719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: