Healthcare Provider Details

I. General information

NPI: 1730842428
Provider Name (Legal Business Name): KENNETH RIJOS ROMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 SOUTHCENTER BLVD
TUKWILA WA
98188-2442
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD FL 1
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 206-444-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: