Provider Demographics
NPI:1942489893
Name:KITCHING, SUBHADRA SHANNIN (LMP)
Entity Type:Individual
Prefix:
First Name:SUBHADRA
Middle Name:SHANNIN
Last Name:KITCHING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SHANNIN
Other - Middle Name:
Other - Last Name:KITCHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2281 116TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3037
Mailing Address - Country:US
Mailing Address - Phone:206-595-7727
Mailing Address - Fax:
Practice Address - Street 1:2281 116TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3037
Practice Address - Country:US
Practice Address - Phone:206-595-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015364174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist