Healthcare Provider Details

I. General information

NPI: 1669678207
Provider Name (Legal Business Name): DANIEL W KOWALS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CULLENS ST NW
YELM WA
98597-9417
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-400-4800
  • Fax: 360-400-4821
Mailing address:
  • Phone: 253-681-6626
  • Fax: 360-330-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00043293
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: