Basic Information
| Provider Information | |||||||||
| NPI: | 1710922067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50095 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065436420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 825 EASTLAKE AVE E | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981094405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065205307 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 04/29/2009 | ||||||||
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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 | 208000000X | 40375 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0207X | 40375 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 2080P0207X | MD60067855 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0052190 | 05 | MT | MEDICAID | KB27908 | 05 | RI | MEDICAID | 0247291 | 01 | WA | L&I | OTHER | 1015998 | 01 | MN | PREFERRED ONE | OTHER | 1932673 | 05 | IA | MEDICAID | 2050779602 | 05 | KS | MEDICAID | 785171 | 01 | MN | ARAZ | OTHER | 36-07131 | 01 | MN | MEDICA | OTHER | 803822800 | 05 | MN | MEDICAID | 14R61BA | 01 | MN | BCBS | OTHER | 41184394337 | 05 | NE | MEDICAID | 32393700 | 05 | WI | MEDICAID | 8537573 | 05 | WA | MEDICAID |