Healthcare Provider Details

I. General information

NPI: 1902046162
Provider Name (Legal Business Name): MATTHEW KAI ELLIOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2009
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E 5TH ST
WEISER ID
83672-2202
US

IV. Provider business mailing address

840 E HILL AVE
MOSES LAKE WA
98837-2238
US

V. Phone/Fax

Practice location:
  • Phone: 208-549-3152
  • Fax: 208-441-0368
Mailing address:
  • Phone: 509-663-8711
  • Fax: 208-441-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOP60455629
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: