Basic Information
| Provider Information | |||||||||
| NPI: | 1093740565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RO | ||||||||
| FirstName: | KUMHEE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
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| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RO | ||||||||
| OtherFirstName: | KUM | ||||||||
| OtherMiddleName: | HEE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 505 S 336TH STREET | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538386180 | ||||||||
| FaxNumber: | 2538386418 | ||||||||
| Practice Location | |||||||||
| Address1: | 10631 EIGHTH AVENUE NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981257298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063642050 | ||||||||
| FaxNumber: | 2063615722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00117834 | WA | N | Nursing Service Providers | Registered Nurse | 363LA2200X | AP30005624 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0206761 | 01 | WA | LABOR & INDUSTRY | OTHER | 9628843 | 05 | WA | MEDICAID | 1063RO | 01 | WA | BSWA | OTHER | 0222334 | 01 | WA | LIWA | OTHER | 21548U | 01 | WA | REGENCE BLUESHIELD | OTHER |