=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033062468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KZTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2026
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 E PIONEER STE B
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-285-8673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 417 E PIONEER STE B
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-285-8673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNCLER
-----------------------------------------------------
Name | MR. DEVAN KRISHTAN MARTIN
-----------------------------------------------------
Credential | AAC
-----------------------------------------------------
Telephone | 253-508-4940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------