Mariya Khomlyak, NAR

Primary specialty

ContractorTaxonomy code 171W00000X

License

750970 Issued in WA

Practice address

2111 Shattuck PL S
Renton, WA 98055-4289

Phone

(425) 277-0452

Fax

(425) 271-1107

NPI assigned

Dec 15, 2014

Last updated

Dec 15, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418601600000",
    "number": "1164820668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 SHATTUCK PL S",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980554289",
            "telephone_number": "425-277-0452",
            "fax_number": "425-271-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 SHATTUCK PL S",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980554289",
            "telephone_number": "425-277-0452",
            "fax_number": "425-271-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOMLYAK",
        "first_name": "MARIYA",
        "credential": "NAR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-15",
        "last_updated": "2014-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "WA",
            "license": "750970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL SERVICE PAYMENT SYSTEM NUMBER",
            "identifier": "156016",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Aydin Khoshkbariie, D.C.
• Maly Khov, PHARM.D
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• Nancy Kiesler, P.T.
• Elizabeth Louise Kijima, ARNP

• Contractor in Renton, WA
• Providers in Renton, WA by specialty
• Contractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.