Provider Demographics
NPI:1447517735
Name:KADING, KELLAN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:KELLAN
Middle Name:JAMES
Last Name:KADING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 BROADWAY
Mailing Address - Street 2:SUITE WW-739
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4379
Mailing Address - Country:US
Mailing Address - Phone:206-386-6721
Mailing Address - Fax:
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:SUITE WW-739
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4379
Practice Address - Country:US
Practice Address - Phone:206-386-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAML60293216208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program