KENT FAMILY PRACTICE PS (NPI# 1043478928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043478928 |
| Entity Type | Organization |
| Organization Name | KENT FAMILY PRACTICE PS |
| Other Organization Name | KENT FAMILY PRACTICE |
| Practice Address |
24604 104th Ave Se Ste 201 Kent WA 98030-5385 |
| Practice Telephone | 2538549799 |
| Practice Fax Number | 4258695682 |
| Mailing Telephone | 2538549799 |
| Mailing Fax Number | 4258695682 |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | DR. BRADEN CARL ANDERSEN (CEO & PRESIDENT) |
| Authorized Official Telephone | 2538549799 |
| Authorized Official Credential | DNP, MBA, ARNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
WA | Ambulatory Health Care Facilities | |
| Y | 207Q00000X | Family Medicine | MD00016879 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | REGENCE BLUE SHIELD | T847 | 01 |
| WA | 1028208 | 05 | |
| WA | DEPT OF LABOR & INDUSTRIES | 6455 | 01 |
| Other Name | Type Code |
|---|---|
| Kent Family Practice | Doing Business As Name - Organization |
| Sui M Twe MD P C | Former Legal Business Name - Organization |
| Street Address |
24604 104TH AVE SE STE 201 |
| City | KENT |
| State | WA |
| Zip Code | 98030-5385 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235762030 | Kimberly Ezinwa Acholonu | Nurse Practitioner | 24604 104th Ave Se Ste 201, Kent, WA 98030-5385 | 2020-02-20 |
| 1821621574 | Rahab Kairu | Nurse Practitioner | 24604 104th Ave Se Ste 201, Kent, WA 98030-5385 | 2020-02-20 |
| 1598292120 | Braden Carl Andersen | Nurse Practitioner | 24604 104th Ave Se Ste 201, Kent, WA 98030-5385 | 2017-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871193193 | Sarah V Swan | Occupational Therapist | 12033 Se 265th St, Kent, WA 98030 | 2020-10-27 |
| 1346889250 | Kaylee Meilahn | Nurse Practitioner | 219 State Ave. N, Suite 220, Kent, WA 98030 | 2019-12-26 |
| 1508417429 | Pamela Stefansky | Technician | 25927 119th Ct Se, Kent, WA 98030 | 2019-09-23 |
| 1144703885 | Healthpoint | Clinic/Center | 219 State Ave N, Ste 100, Kent, WA 98030 | 2018-09-10 |
| 1932681921 | Johana Sanchez-vidales | Massage Therapist | 24837 104th Ave Se #100, Kent, WA 98030 | 2018-09-05 |
| 1265925309 | Linda Tomkins | Chiropractor | 12901 Se Kent-kangley Rd, Kent, WA 98030 | 2018-06-13 |
| 1952809543 | Sarah Rose Collins | Massage Therapist | 13003 Se Kent Kangley Rd Ste 110, Kent, WA 98030 | 2018-01-29 |
| 1942726815 | Alexandra B Zigmont | Physical Therapist | 12926 Se Kent Kangley Road, Kent, WA 98030 | 2017-08-22 |
| 1659801256 | Mitra Lal Dhital | Counselor | 3639 Mlk Jr Way S Seattle, Seattle, WA 98030 | 2017-06-15 |
| 1952838658 | Elizabeth Burson | Registered Nurse | 25742 104th Avenue Se, Kent, WA 98030 | 2017-05-12 |
| Find all providers in zip 98030 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619409273 | Josiah B Belzer | Family Medicine | 26004 104th Ave Se Ste 101, Kent, WA 98030-7677 | 2017-03-31 |
| 1538554019 | Rachel Elena Cullison | Family Medicine | 401 Devon Pl Ste 215, Kent, OH 44240-6483 | 2015-04-01 |
| 1528222569 | Payal Mitesh Shah | Family Medicine | 1314 Central Ave S Ste 102, Kent, WA 98032-7430 | 2008-07-17 |
| 1457521619 | Russell W Faria Do PC | Family Medicine | 15215 Se 272nd St Ste 103, Kent, WA 98042-4215 | 2008-03-04 |
| 1437215472 | Sui M Twe | Family Medicine | 10056 Se 240th St Ste D, Kent, WA 98031-5126 | 2006-12-27 |
| 1780746172 | Charanjit K Lamba | Family Medicine | 24703 38th Ave S, Kent, WA 98032-4111 | 2006-12-14 |
| 1487765442 | Lester Pittle | Family Medicine | 325 W Gowe St, Kent, WA 98032-5892 | 2006-08-31 |
| 1568471621 | Rashid Daud | Family Medicine | 219 State Ave N Ste 100, Kent, WA 98030-4543 | 2006-08-07 |
| 1043235427 | Angela Jane Dejulius | Family Medicine | 1365 Kelso Rd, Kent, OH 44240 | 2006-07-13 |
| 1194779629 | Harpreet Singh Chhokar | Family Medicine | 10830 Se Kent Kangley Rd, 100a, Kent, WA 98030-9959 | 2006-05-20 |
| Find all providers in KENT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.