Healthcare Provider Details

I. General information

NPI: 1841229531
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF KITSAP COUNTY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2771 HEMLOCK ST SUITE 201
BREMERTON WA
98310-2689
US

IV. Provider business mailing address

2771 HEMLOCK ST SUITE 201
BREMERTON WA
98310-2689
US

V. Phone/Fax

Practice location:
  • Phone: 360-377-7634
  • Fax: 360-479-6157
Mailing address:
  • Phone: 360-377-7634
  • Fax: 360-479-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number602421424
License Number StateWA

VIII. Authorized Official

Name: DR. KENNETH A COGEN
Title or Position: OWNER
Credential: MD
Phone: 360-377-7634