Healthcare Provider Details

I. General information

NPI: 1134700453
Provider Name (Legal Business Name): OKENWA OKOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 NE PACIFIC ST FL 3 MAIN HOSPITAL
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

4312 37TH AVE NE
SEATTLE WA
98105-5629
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4022
  • Fax:
Mailing address:
  • Phone: 832-620-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.MD.70095766
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: