Provider Demographics
NPI:1194573360
Name:KIGGUNDU, KARL JOSEPH
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:JOSEPH
Last Name:KIGGUNDU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KARL
Other - Middle Name:JOSEPH
Other - Last Name:KIGGUNDU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 127TH ST SE UNIT B303
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5135
Mailing Address - Country:US
Mailing Address - Phone:240-639-9444
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W STE 100
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5600
Practice Address - Country:US
Practice Address - Phone:425-309-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician