Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ML60655392 | WA |
NPI | 1003278748 |
---|---|
Provider Name | Dr. Kumara Raja Sundar |
First Address | Burien, WA 98166-1912 |
Second Address | Burien, WA 98166-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 24/05/2021 |