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General NPI Number Information
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NPI Number | 1912326836
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES KOCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 915 ANDERSON DR
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City | ABERDEEN
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State | WA
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Zip | 98520-1006
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Country | US
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Telephone | 360-532-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 FOOTHILL BLVD # 1014
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3516
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 21697
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MED-PHYS-COM-LIC-158
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 15714A
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C4550
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | TD61442314
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 27283
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License Number State | NV
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Taxonomy #7
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C179538
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License Number State | CA
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