Healthcare Provider Details

I. General information

NPI: 1245808237
Provider Name (Legal Business Name): BENJAMIN JOSEPH KIYOSHI GREENE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 07/23/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W SUMMIT PKWY LOWR LEVEL1
SPOKANE WA
99201-7033
US

IV. Provider business mailing address

2296 E. 30TH AVE. APT. 232
SPOKANE WA
99203
US

V. Phone/Fax

Practice location:
  • Phone: 509-579-4300
  • Fax: 509-317-9542
Mailing address:
  • Phone: 208-553-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberOP61667154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: