Provider Demographics
NPI:1205469889
Name:KIM, SHANNON J (CPO, LCPO)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:CPO, LCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 EASTLAKE AVE E STE 300 SEATTLE, WA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-598-4026
Mailing Address - Fax:206-598-4761
Practice Address - Street 1:501 EASTLAKE AVE E STE 300 SEATTLE, WA
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:206-598-4026
Practice Address - Fax:206-598-4761
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist