MEDICARE: KAIULANI WILSON MORIMOTO MD FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	MD00036728	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124011408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIULANI WILSON MORIMOTO MD FACS

Provider Business Mailing Address
First Line	:	12615 E MISSION AVE STE 105
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1047
Country	:	US
Telephone Number	:	509-315-4415
Fax Number	:	509-315-8204

Provider Business Practice Location Address
First Line	:	12615 E MISSION AVE STE 105
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1047
Country	:	US
Telephone Number	:	509-315-4415
Fax Number	:	509-315-8204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/17/2014

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