Provider Demographics
NPI:1124829718
Name:KAKAR, SIDDIQULLAH (MPA)
Entity type:Individual
Prefix:
First Name:SIDDIQULLAH
Middle Name:
Last Name:KAKAR
Suffix:
Gender:
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18836 111TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-6465
Mailing Address - Country:US
Mailing Address - Phone:206-945-5729
Mailing Address - Fax:
Practice Address - Street 1:18836 111TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-6465
Practice Address - Country:US
Practice Address - Phone:206-945-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator