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1205926169

NPI Code Detail

MEDICARE: KEVIN DOUGLAS O'BRIEN

MEDICARE: KEVIN DOUGLAS O'BRIEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	MD00023041	WA
2	207RC0000X	Cardiovascular Disease Physician	MD00023041	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	000107662	OTHER	WA	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0231657	OTHER	WA	L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6437	OTHER		INTERNAL ID-MOTOR VEHICLE ID

General Provider Information

NPI Number	:	1205926169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DOUGLAS O'BRIEN

Provider Business Mailing Address
First Line	:	PO BOX 50095
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98145-5095
Country	:	US
Telephone Number	:	206-520-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-6043
Country	:	US
Telephone Number	:	206-598-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	03/17/2018

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Directions to “ KEVIN DOUGLAS O'BRIEN ” Practice Location

Language	Start Address	Practice Location

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