Provider Demographics
NPI:1104064328
Name:KAWAFUNE, CYNTHIA R (LMP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:KAWAFUNE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 N OLYMPIC AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1299
Mailing Address - Country:US
Mailing Address - Phone:360-403-3075
Mailing Address - Fax:
Practice Address - Street 1:437 N OLYMPIC AVE STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1299
Practice Address - Country:US
Practice Address - Phone:360-403-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA007766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist