Provider Demographics
NPI:1285747139
Name:REIS, KIM S (DO)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:S
Last Name:REIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 N MEADOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4928
Mailing Address - Country:US
Mailing Address - Phone:206-434-0437
Mailing Address - Fax:
Practice Address - Street 1:1321 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1665
Practice Address - Country:US
Practice Address - Phone:425-261-4042
Practice Address - Fax:425-262-4051
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-454207LP2900X
CA20A7595207LP2900X
WAOP60322795207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00007956Medicaid
AL51079556OtherBCBS#
CACU543ZMedicare PIN
F36931Medicare UPIN
AL00007956Medicaid