Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | MD00029686 | WA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD00029686 | WA |
NPI | 1497898969 |
---|---|
Provider Name | Kristen Sean Moe |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231580 | L&I (01) | WA |
1497898969 | (05) | WA |
8326 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
H04034 | (02) |