Provider Demographics
NPI:1881120418
Name:KING, SUMMER (LMP)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12036 100TH AVE NE
Mailing Address - Street 2:UNIT: K304
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3849
Mailing Address - Country:US
Mailing Address - Phone:920-265-8843
Mailing Address - Fax:
Practice Address - Street 1:13353 NE BEL RED RD
Practice Address - Street 2:#103
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2329
Practice Address - Country:US
Practice Address - Phone:425-679-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60736635172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker