Individual
PHALLA T. KITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
325 9TH AVE, SEATTLE, WA 98104-2499
(206) 744-3000
Mailing address
BOX 359895, 325 9TH AVE, SEATTLE, WA 98104-2499
(206) 744-4192
(206) 744-8689
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10001382
WA
363AM0700X
Medical Physician Assistant
Primary
PA10001382
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0201012
L&I PIN
WA
05
—
8435547
—
WA
01
—
U58648
REGENCE BLUE SHIELD PIN
WA
Enumeration date
08/09/2006
Last updated
06/24/2011
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