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General NPI Number Information
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NPI Number | 1225436512
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Entity Type | Organization
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Legal Business Name | CYNTHIA KELLER MD
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 12815 120TH AVE NE SUITRE A
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City | KIRKLAND
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State | WA
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Zip | 98034-3003
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Country | US
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Telephone | 425-898-4732
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Fax |
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Provider Business Mailing Address
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Address Line | 12815 120TH AVE NE SUITRE A
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City | KIRKLAND
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State | WA
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Zip | 98034
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Country | US
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Telephone | 425-898-4732
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA MARIE KELLER
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Credential | MD
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Telephone | 42589874732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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