Healthcare Provider Details

I. General information

NPI: 1720728694
Provider Name (Legal Business Name): JASMINE KIPKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1801 W 47TH ST
CLEVELAND OH
44102-3411
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-3300
  • Fax:
Mailing address:
  • Phone: 206-598-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: