Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0019926 | WA |
NPI | 1063429850 |
---|---|
Provider Name | Dr. Kenneth D Faw |
First Address | Kirkland, WA 98034-7467 |
Second Address | Kirkland, WA 98034-7467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |