Provider Demographics
NPI:1548607450
Name:ALAN ITKIN PLLC
Entity Type:Organization
Organization Name:ALAN ITKIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ITKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:425-442-2607
Mailing Address - Street 1:2452 W LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5536
Mailing Address - Country:US
Mailing Address - Phone:425-442-2607
Mailing Address - Fax:
Practice Address - Street 1:11656 98TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4216
Practice Address - Country:US
Practice Address - Phone:425-823-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60120226363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty