Basic Information
| Provider Information | |||||||||
| NPI: | 1891268884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KISH | ||||||||
| FirstName: | SARAH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1455 NW IRVING ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972092277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036848252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 531 BROADWAY E STE 10 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981025023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036848252 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2019 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA061117 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | PA61090865 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.