Provider Demographics
NPI:1164397402
Name:MUNGAI, SUSAN KANYI
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KANYI
Last Name:MUNGAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 CECILE CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5976
Mailing Address - Country:US
Mailing Address - Phone:206-566-1919
Mailing Address - Fax:
Practice Address - Street 1:9005 CECILE CT SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-5976
Practice Address - Country:US
Practice Address - Phone:206-566-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA758429311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home