MEDICARE: DR. KYLE JORDAN M.D.

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	207Q00000X	Family Medicine Physician	MD60972594	WA

General Provider Information

NPI Number	:	1215387345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE JORDAN M.D.

Provider Business Mailing Address
First Line	:	1 EMBARCADERO CTR STE 1900
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-3723
Country	:	US
Telephone Number	:	415-658-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 BALLARD AVE NW FL 2
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4806
Country	:	US
Telephone Number	:	888-663-6331
Fax Number	:	415-252-7176

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

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/04/2026

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