Healthcare Provider Details

I. General information

NPI: 1356304000
Provider Name (Legal Business Name): JASON KAOPUA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SE EVERETT MALL WAY BLDG D
EVERETT WA
98208-3208
US

IV. Provider business mailing address

111 SE EVERETT MALL WAY BLDG D
EVERETT WA
98208-3208
US

V. Phone/Fax

Practice location:
  • Phone: 425-267-3333
  • Fax: 425-267-3335
Mailing address:
  • Phone: 425-267-3333
  • Fax: 425-267-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.00009149
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: