Provider Demographics
NPI:1942593587
Name:KONGKACHEN, SARINDA (MD)
Entity Type:Individual
Prefix:
First Name:SARINDA
Middle Name:
Last Name:KONGKACHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-397-1700
Mailing Address - Fax:425-335-5145
Practice Address - Street 1:1909 214TH ST SE STE 110
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4412
Practice Address - Country:US
Practice Address - Phone:425-488-4988
Practice Address - Fax:425-488-4993
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098354207Q00000X
ORMD165772207Q00000X
WAMD60733286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine