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General NPI Number Information
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NPI Number | 1053592022
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Entity Type | Organization
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Legal Business Name | C J KUAN MD INC PS
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1111 PACIFIC AVE STE B
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City | EVERETT
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State | WA
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Zip | 98201-4200
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Country | US
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Telephone | 360-982-2210
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Fax | 251-286-2102
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Provider Business Mailing Address
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Address Line | PO BOX 5182
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City | EVERETT
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State | WA
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Zip | 98206-5182
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Country | US
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Telephone | 360-982-2210
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN / PRESIDENT
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Name | CHIA-JEN KUAN
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Credential | MD
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Telephone | 360-982-2210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD00031127
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License Number State | WA
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