Individual
MR. KENNETH ALAN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16817 223RD AVE E, ORTING, WA 98360-9120
(360) 897-8300
(360) 897-8302
Mailing address
PO BOX 458, ORTING, WA 98360-0458
(360) 897-8300
(360) 897-8302
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
602 876 041
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7144942
WASHINGTON PROVIDER NUMBER
WA
Enumeration date
08/13/2009
Last updated
08/13/2009
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