Individual
DR. KIM SHANNON MALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1221 MADISON ST, SUITE 1218, SEATTLE, WA 98104-1356
(206) 215-2323
(206) 215-2320
Mailing address
1221 MADISON ST, SUITE 1218, SEATTLE, WA 98104-1356
(206) 215-2323
(206) 215-2320
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD00027008
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1078542
—
WA
01
—
32114
LABOR AND INDUSTRIES
WA
Enumeration date
05/03/2007
Last updated
07/08/2007
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