Provider Demographics
NPI:1588156202
Name:BO, KYAW THU (MD)
Entity type:Individual
Prefix:DR
First Name:KYAW
Middle Name:THU
Last Name:BO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:THU
Other - Last Name:BO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3900
Mailing Address - Fax:
Practice Address - Street 1:401 2ND ST
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-3008
Practice Address - Country:US
Practice Address - Phone:360-568-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301115294207Q00000X
WAMD61142454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine