Provider Demographics
NPI:1821122557
Name:H LEE KILBURN MD PS
Entity Type:Organization
Organization Name:H LEE KILBURN MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-715-0738
Mailing Address - Street 1:207 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5319
Mailing Address - Country:US
Mailing Address - Phone:425-822-4119
Mailing Address - Fax:425-822-8034
Practice Address - Street 1:207 8TH AVE W
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5319
Practice Address - Country:US
Practice Address - Phone:425-822-4119
Practice Address - Fax:425-822-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009032173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1460401Medicaid
WA1460401Medicaid