Jill Rose Kandora, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 60513573 Issued in WA

Practice address

20120 Ballinger Way NE Ste a-01
Shoreline, WA 98155-1117

Phone

(206) 365-9000

Fax

(206) 365-9001

NPI assigned

Dec 1, 2014

Last updated

Dec 1, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417392000000",
    "number": "1467859827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11032 GREENWOOD AVE N UNIT C",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981337633",
            "telephone_number": "516-754-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20120 BALLINGER WAY NE STE A-01",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981551117",
            "telephone_number": "206-365-9000",
            "fax_number": "206-365-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDORA",
        "first_name": "JILL",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-01",
        "last_updated": "2014-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA 60513573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.