Individual
IAN KEAUPUNI AWAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
15214 CANYON RD E STE 120, PUYALLUP, WA 98375-7457
(253) 539-6078
(253) 539-6045
Mailing address
15214 CANYON RD E STE 120, PUYALLUP, WA 98375-7457
(253) 539-6078
(253) 539-6045
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
AMD-1033
HI
363A00000X
Physician Assistant
PA61491021
WA
363AM0700X
Medical Physician Assistant
Primary
PA61491021
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2273642
—
WA
Enumeration date
03/03/2021
Last updated
08/15/2024
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