Provider Demographics
NPI:1538309661
Name:JAMES KUSTIN MD;PS
Entity type:Organization
Organization Name:JAMES KUSTIN MD;PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARONA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:425-462-9612
Mailing Address - Street 1:1370 116TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3825
Mailing Address - Country:US
Mailing Address - Phone:425-462-6100
Mailing Address - Fax:425-635-0742
Practice Address - Street 1:1370 116TH AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3825
Practice Address - Country:US
Practice Address - Phone:425-462-6100
Practice Address - Fax:425-635-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601182755261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217000312Medicare Oscar/Certification