Provider Demographics
NPI:1972033553
Name:ENS, DUSTIN KYLE (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:KYLE
Last Name:ENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 177TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1968
Mailing Address - Country:US
Mailing Address - Phone:360-794-2829
Mailing Address - Fax:
Practice Address - Street 1:16550 177TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1968
Practice Address - Country:US
Practice Address - Phone:360-794-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60983313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine