MEDICARE: DR. JEFFREY KARL KIKI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OP 60120424	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0261765	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1003874017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY KARL KIKI D.O.

Provider Business Mailing Address
First Line	:	3950 KEENE RD
Second Line	:
City	:	WEST RICHLAND
State	:	WA
Zip	:	99353-4901
Country	:	US
Telephone Number	:	509-942-3130
Fax Number	:	509-628-8335

Provider Business Practice Location Address
First Line	:	3950 KEENE RD
Second Line	:
City	:	WEST RICHLAND
State	:	WA
Zip	:	99353
Country	:	US
Telephone Number	:	509-942-3627
Fax Number	:	509-628-8335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/01/2021

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