Provider Demographics
NPI:1952183592
Name:LEMMA, WENDWESEN KASSA (MD)
Entity Type:Individual
Prefix:
First Name:WENDWESEN
Middle Name:KASSA
Last Name:LEMMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 FIR ST UNIT 242
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-5144
Mailing Address - Country:US
Mailing Address - Phone:425-626-9905
Mailing Address - Fax:
Practice Address - Street 1:3020 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-3317
Practice Address - Country:US
Practice Address - Phone:253-844-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMDCE.ML.61488604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine