Provider Demographics
NPI:1700065406
Name:KUKINO, CANDACE (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:KUKINO
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2848
Mailing Address - Country:US
Mailing Address - Phone:206-323-5770
Mailing Address - Fax:
Practice Address - Street 1:1625 19TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2848
Practice Address - Country:US
Practice Address - Phone:206-323-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004711231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB11849Medicare PIN