Provider Demographics
NPI:1821574419
Name:DADA, KINZA (OD)
Entity Type:Individual
Prefix:
First Name:KINZA
Middle Name:
Last Name:DADA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NE NORTHGATE WAY
Mailing Address - Street 2:SPC 1101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8538
Mailing Address - Country:US
Mailing Address - Phone:206-364-2273
Mailing Address - Fax:206-361-4592
Practice Address - Street 1:401 NE NORTHGATE WAY
Practice Address - Street 2:SPC 1101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8538
Practice Address - Country:US
Practice Address - Phone:206-364-2273
Practice Address - Fax:206-361-4592
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008847152W00000X
WA61188462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2206386Medicaid
WA61188462OtherLICENSE