Provider Demographics
NPI:1578330650
Name:KYNNAP, BRYAN DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DAVID
Last Name:KYNNAP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12039 NE 128TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3029
Mailing Address - Country:US
Mailing Address - Phone:425-899-5590
Mailing Address - Fax:
Practice Address - Street 1:10515 NE 136TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2021
Practice Address - Country:US
Practice Address - Phone:094-813-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61515871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant