Provider Demographics
NPI:1740611532
Name:KINOSHITA, KEI (LMP)
Entity Type:Individual
Prefix:
First Name:KEI
Middle Name:
Last Name:KINOSHITA
Suffix:
Gender:M
Credentials:LMP
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 2751
Mailing Address - Street 2:C/O AJ SOCCER
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4323 ISSAQUAH PINE LAKE RD SE
Practice Address - Street 2:UNIT 503
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-5266
Practice Address - Country:US
Practice Address - Phone:425-200-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60412396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist