Provider Demographics
NPI:1922315282
Name:SHEN, KATHERINE Y (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:Y
Last Name:SHEN
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 1:14050 JUANITA DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9708
Mailing Address - Country:US
Mailing Address - Phone:206-218-7436
Mailing Address - Fax:
Practice Address - Street 1:14050 JUANITA DR NE STE A
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-9708
Practice Address - Country:US
Practice Address - Phone:425-820-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4827152W00000X
WA60242185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist