Living Well Kent Collaborative

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

Legal business name

LIVING WELL KENT COLLABORATIVE

Doing business as

Living Well Kent Collaborative

Practice address

515 W Harrison St Ste 208
Kent, WA 98032-4403

Phone

(253) 457-2964

NPI assigned

Apr 13, 2019

Organization subpart

No

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

Authorized official

Name

Shamso Issak

Title

Executive Director

Phone

(253) 457-2964

Specialties & licenses 1

Addresses

Other names 1

• Living Well Kent Collaborative Doing business as

Locations

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

{
    "created_epoch": "1555113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555113600000",
    "number": "1760945968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10605 SE 240TH ST # 232",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980314903",
            "telephone_number": "253-457-2964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 W HARRISON ST STE 208",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980324403",
            "telephone_number": "253-457-2964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL KENT COLLABORATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-13",
        "last_updated": "2019-04-13",
        "status": "A",
        "authorized_official_last_name": "ISSAK",
        "authorized_official_first_name": "SHAMSO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "253-457-2964"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Living Well Kent Collaborative",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glenn Ronald Lirman, ARNP
• Karen Ann Little
• Shih-Yao Liu
• Timothy C Liu, DDS
• Live Well Alliance, LLC
• Clarissa Asenath Livingston, LMP
• Diane Jean Livingston
• Krystal Livingston
• Erin Kahaunani Lloyd, RAAC
• Hayley Lofquist, DMD

• Nutrition Education Nutritionist in Kent, WA
• Providers in Kent, WA by specialty
• Nutrition Education Nutritionist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2019; 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.