Provider Demographics
NPI:1831110782
Name:RAZAN R AL-KUDSI MD
Entity type:Organization
Organization Name:RAZAN R AL-KUDSI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:AL KUDSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-242-8837
Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:#401
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3049
Mailing Address - Country:US
Mailing Address - Phone:206-242-8837
Mailing Address - Fax:
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 401
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028577207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110061080OtherRR MEDICARE
WA1073238Medicaid
WAG8864040Medicare PIN