Provider Demographics
NPI:1447232384
Name:KIHICHAK, LUBA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUBA
Middle Name:
Last Name:KIHICHAK
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:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:22850 NE 8TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7256
Practice Address - Country:US
Practice Address - Phone:425-898-0305
Practice Address - Fax:425-898-8825
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016178207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2955KIOtherBLUE SHIELD
WA080124614OtherMEDICARE RAILROAD
WA8204166Medicaid
WA117516OtherLABOR & INDUSTRIES
WAG8800801Medicare PIN
WA117516OtherLABOR & INDUSTRIES
WAG8862038Medicare PIN
WAG8897695Medicare PIN