Healthcare Provider Details

I. General information

NPI: 1750086724
Provider Name (Legal Business Name): NILS KJOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 REPUBLICAN ST # 358047
SEATTLE WA
98109-4725
US

IV. Provider business mailing address

6308 SE 22ND ST
MERCER ISLAND WA
98040-2010
US

V. Phone/Fax

Practice location:
  • Phone: 206-221-1452
  • Fax:
Mailing address:
  • Phone: 206-948-1797
  • 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: