Provider Demographics
NPI:1235440330
Name:KIPP, ALEX JOSEPH (MD, MALS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JOSEPH
Last Name:KIPP
Suffix:
Gender:M
Credentials:MD, MALS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 TALBOT RD S STE 401
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5738
Mailing Address - Country:US
Mailing Address - Phone:425-690-7592
Mailing Address - Fax:425-690-9414
Practice Address - Street 1:3915 TALBOT RD S STE 401
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5738
Practice Address - Country:US
Practice Address - Phone:425-690-7592
Practice Address - Fax:425-690-9414
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC170078207Q00000X
ORMD179582207Q00000X
WAMD60287601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33708860Medicaid