Provider Demographics
NPI: | 1942784160 |
---|---|
Name: | CUI, DAVID (PA-C) |
Entity type: | Individual |
Prefix: | |
First Name: | DAVID |
Middle Name: | |
Last Name: | CUI |
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: | 14841 179TH AVE SE STE 330 |
Mailing Address - Street 2: | |
Mailing Address - City: | MONROE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98272-1127 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-794-3300 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 14841 179TH AVE SE STE 330 |
Practice Address - Street 2: | |
Practice Address - City: | MONROE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98272-1127 |
Practice Address - Country: | US |
Practice Address - Phone: | 360-794-3300 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-09-24 |
Last Update Date: | 2025-01-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | PA61006080 | 363AS0400X |
363A00000X | ||
CA | 390200000X | |
57499 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
Yes | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |