Provider Demographics
NPI:1518352541
Name:GELFENBEYN, KIRILL MIKHAIL (DO)
Entity Type:Individual
Prefix:
First Name:KIRILL
Middle Name:MIKHAIL
Last Name:GELFENBEYN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CAMPBELL WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3323
Mailing Address - Country:US
Mailing Address - Phone:360-377-1355
Mailing Address - Fax:360-377-1558
Practice Address - Street 1:1225 CAMPBELL WAY STE 201
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3323
Practice Address - Country:US
Practice Address - Phone:360-377-1355
Practice Address - Fax:360-377-1558
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60912776207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2142713Medicaid