Provider Demographics
NPI:1265490700
Name:HO, KINGMAN K (MD)
Entity Type:Individual
Prefix:
First Name:KINGMAN
Middle Name:K
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-7458
Practice Address - Street 1:24604 104TH AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5385
Practice Address - Country:US
Practice Address - Phone:253-395-2001
Practice Address - Fax:253-852-8012
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093426Medicaid
WA110116679OtherRR MEDICARE
WA0100973OtherL&I
WAHO3159OtherREGENCE
WA217115401Medicare PIN
WA1093426Medicaid