Organization
KELVIN K MA MD INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELVIN K MA MD (PRESIDENT)
(253) 840-0406
Entity
Organization
Contact information
Practice address
201 15TH AVE SW, STE D, PUYALLUP, WA 98371-0226
(253) 840-0406
(253) 840-3352
Mailing address
PO BOX 1148, 201 15TH AVE SW STE D, PUYALLUP, WA 98371-0226
(253) 840-0406
(253) 840-3352
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD00022157
WA
2084N0400X
Neurology Physician
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0067266
L & I
WA
05
—
1302264
—
WA
Enumeration date
09/07/2006
Last updated
03/17/2018
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