Provider Demographics
NPI:1740362136
Name:KIESLING, VICTOR JOHN JR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOHN
Last Name:KIESLING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:STE A221
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-572-6835
Mailing Address - Fax:253-573-9238
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:STE A221
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-572-6835
Practice Address - Fax:253-573-9238
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036292208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84400Medicare UPIN