Basic Information
| Provider Information | |||||||||
| NPI: | 1306880430 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARRELL | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FARRELL | ||||||||
| OtherFirstName: | KIM | ||||||||
| OtherMiddleName: | ELISABETH | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15811 AMBAUM BLVD SW | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064392988 | ||||||||
| FaxNumber: | 2064313939 | ||||||||
| Practice Location | |||||||||
| Address1: | 10030 SW 210TH ST | ||||||||
| Address2: | |||||||||
| City: | VASHON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980706584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064633671 | ||||||||
| FaxNumber: | 2064633613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00036422 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.