Healthcare Provider Details

I. General information

NPI: 1306880430
Provider Name (Legal Business Name): KIM FARRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM ELISABETH FARRELL

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 SW 210TH ST
VASHON WA
98070-6584
US

IV. Provider business mailing address

15811 AMBAUM BLVD SW SUITE 170
BURIEN WA
98166-3066
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-3671
  • Fax: 206-463-3613
Mailing address:
  • Phone: 206-439-2988
  • Fax: 206-431-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00036422
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: