Healthcare Provider Details

I. General information

NPI: 1700065406
Provider Name (Legal Business Name): CANDACE KIYOKO KUKINO AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 15TH AVE NE
SHORELINE WA
98155-7196
US

IV. Provider business mailing address

4034 DAYTON AVE N
SEATTLE WA
98103-7721
US

V. Phone/Fax

Practice location:
  • Phone: 206-361-2990
  • Fax:
Mailing address:
  • Phone: 206-335-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00004711
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: