Provider Demographics
NPI:1215089966
Name:KAUFMANN, SUSAN S (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:S
Other - Last Name:KENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11913 NE 195TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3147
Mailing Address - Country:US
Mailing Address - Phone:425-489-3100
Mailing Address - Fax:425-489-3183
Practice Address - Street 1:11913 NE 195TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3147
Practice Address - Country:US
Practice Address - Phone:425-489-3100
Practice Address - Fax:425-489-3183
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA233205OtherLNI
WA8145856Medicaid
WAG8877735Medicare PIN
WA8145856Medicaid
WAG000135708Medicare PIN