Provider Demographics
NPI:1497790687
Name:AL KUDSI, RAZAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAZAN
Middle Name:R
Last Name:AL KUDSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3049
Mailing Address - Country:US
Mailing Address - Phone:206-242-8837
Mailing Address - Fax:206-431-5549
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 401
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-8837
Practice Address - Fax:206-431-5549
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00028577207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073238Medicaid
WA110061080OtherRR MEDICARE
WA110061080OtherRR MEDICARE
WA1073238Medicaid