Healthcare Provider Details

I. General information

NPI: 1023218617
Provider Name (Legal Business Name): JONATHAN CHAIM KOPELOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 116TH AVE NE SUITE 915
BELLEVUE WA
98004-3804
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-3938
  • Fax: 425-454-2568
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD60564654
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMD60564654
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: