Provider Demographics
NPI:1336752906
Name:KYLYUKH, LEONID FEDOROVYCH
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:FEDOROVYCH
Last Name:KYLYUKH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5759
Mailing Address - Country:US
Mailing Address - Phone:425-255-4742
Mailing Address - Fax:
Practice Address - Street 1:920 N 1ST ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5759
Practice Address - Country:US
Practice Address - Phone:425-255-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61220795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant