Provider Demographics
NPI:1144361304
Name:O'BARA, KENNETH J (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:O'BARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6720 FORT DENT WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-8508
Mailing Address - Country:US
Mailing Address - Phone:206-242-3651
Mailing Address - Fax:206-433-7946
Practice Address - Street 1:6720 FORT DENT WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8508
Practice Address - Country:US
Practice Address - Phone:206-242-3651
Practice Address - Fax:206-433-7946
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018701208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA171941OtherLABOR & INDUSTRIES
WA171941OtherLABOR & INDUSTRIES