Provider Demographics
NPI:1225867245
Name:BOSTON, LEON KINLEY
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:KINLEY
Last Name:BOSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 DAVIS AVE S APT BB203
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6254
Mailing Address - Country:US
Mailing Address - Phone:206-571-4400
Mailing Address - Fax:
Practice Address - Street 1:4702 DAVIS AVE S APT BB203
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6254
Practice Address - Country:US
Practice Address - Phone:206-571-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist