Healthcare Provider Details

I. General information

NPI: 1710990197
Provider Name (Legal Business Name): MIKIKO FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14406 NE 20TH AVE
VANCOUVER WA
98686-1448
US

IV. Provider business mailing address

14406 NE 20TH AVE
VANCOUVER WA
98686-1448
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-3084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberWA MD00035889
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOR MD21079
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG 48562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: