Healthcare Provider Details

I. General information

NPI: 1720744667
Provider Name (Legal Business Name): KUKUIA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 6TH AVE STE 100
TACOMA WA
98405-3300
US

IV. Provider business mailing address

1712 6TH AVE STE 100
TACOMA WA
98405-3300
US

V. Phone/Fax

Practice location:
  • Phone: 206-259-3338
  • Fax:
Mailing address:
  • Phone: 206-259-3338
  • Fax: 253-366-7283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RICH KUKUIA
Title or Position: CEO
Credential:
Phone: 206-251-2054