Provider Demographics
NPI:1902223498
Name:OBENG, KWAME (PA-C)
Entity type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:OBENG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:360-742-5000
Mailing Address - Fax:
Practice Address - Street 1:3622 ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5081
Practice Address - Country:US
Practice Address - Phone:360-742-5000
Practice Address - Fax:360-742-5019
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60443324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant