Provider Demographics
NPI:1821485020
Name:WILEY, KIAL LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:KIAL
Middle Name:LYNNE
Last Name:WILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIAL
Other - Middle Name:LYNNE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14410 SE PETROVITSKY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8900
Mailing Address - Country:US
Mailing Address - Phone:425-690-3405
Mailing Address - Fax:425-690-9405
Practice Address - Street 1:14410 SE PETROVITSKY RD STE 104
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8900
Practice Address - Country:US
Practice Address - Phone:425-690-3405
Practice Address - Fax:425-690-9405
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60870304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program