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General NPI Number Information
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NPI Number | 1245808237
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Entity Type | Individual
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Provider Name | BENJAMIN JOSEPH KIYOSHI GREENE DO
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Gender | Male
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1303 W SUMMIT PKWY LOWR LEVEL1
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City | SPOKANE
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State | WA
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Zip | 99201-7033
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Country | US
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Telephone | 509-579-4300
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Fax | 509-317-9542
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Provider Business Mailing Address
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Address Line | 2296 E. 30TH AVE. APT. 232
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City | SPOKANE
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State | WA
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Zip | 99203
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Country | US
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Telephone | 208-553-5229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | OP61667154
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License Number State | WA
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