Healthcare Provider Details

I. General information

NPI: 1659407203
Provider Name (Legal Business Name): BENO MILAN KUHARICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NW MYHRE RD
SILVERDALE WA
98383
US

IV. Provider business mailing address

9621 RIDGETOP BLVD NW
SILVERDALE WA
98383-8502
US

V. Phone/Fax

Practice location:
  • Phone: 360-830-1106
  • Fax: 360-830-1385
Mailing address:
  • Phone: 360-830-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOP60164791
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP60164791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: