=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114310729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAYKAUS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2015
-----------------------------------------------------
Last Update Date | 03/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12671 SE 169TH PL
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98058-6133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-237-2271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 58144
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98058-1144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VERA KAYKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-237-2271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | MC6600
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------