Basic Information
| Provider Information | |||||||||
| NPI: | 1477524429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLINCH | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 MADISON ST | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981041172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062648100 | ||||||||
| FaxNumber: | 2062648689 | ||||||||
| Practice Location | |||||||||
| Address1: | 12333 NE 130TH LN | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258995500 | ||||||||
| FaxNumber: | 4258995529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2006 | ||||||||
| LastUpdateDate: | 10/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00035757 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.