Provider Demographics
NPI:1083857817
Name:ANDRADE, KRISTINE EMALINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:EMALINE
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:EMALINE
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD605921752085P0229X, 2085R0202X
CAA1066332085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0407799OtherL&I-RADIA KING COUNTY
WA0407881OtherL&I-EVERGREEN RADIA
WA0407893OtherL&I-SEATTLE RADIOLOGY
WA2134326Medicaid
WA0407798OtherL&I-RADIA REST OF WA
WA0407889OtherL&I-SOUTH SOUND RADIOLOGY
WA0407799OtherL&I-SWEDISH RADIA EDMONDS