Individual
KATHLEEN J PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(206) 223-6600
Mailing address
1100 9TH AVE, MS:M4-PA, SEATTLE, WA 98101-2756
(206) 515-5811
(206) 515-5886
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MD00040435
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039577
L&I
WA
05
—
8321358
—
WA
01
—
9071PA
INDIVIDUAL BLUE SHIELD
WA
01
—
US7466375
AETNA/USHC PIN
WA
Enumeration date
07/26/2006
Last updated
06/27/2008
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