Provider Demographics
NPI:1326061748
Name:KITA, MARIKO (MD)
Entity Type:Individual
Prefix:
First Name:MARIKO
Middle Name:
Last Name:KITA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY
Mailing Address - Street 2:MS: M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:MS: X7-NEO
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000385792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130022126OtherRAILROAD MEDICARE
WA8255994Medicaid
WA4344KIOtherBLUE SHIELD
WAMD6217WOtherALASKA MEDICAID
WA0039590OtherLABOR & INDUSTRY
WAUS2322528OtherAETNA/USHC SPECIALIST
WAMD6217WOtherALASKA MEDICAID
WA0039590OtherLABOR & INDUSTRY
WAUS2322528OtherAETNA/USHC SPECIALIST
130022126OtherRAILROAD MEDICARE
WAG8920817Medicare PIN