Healthcare Provider Details

I. General information

NPI: 1720075294
Provider Name (Legal Business Name): EVA KOJNOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MINOR AVE SUITE 300
SEATTLE WA
98104-2120
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-9500
  • Fax: 206-386-9605
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00034799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: