MEDICARE: TARJA KAAKKO

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	1223P0221X	Pediatric Dentistry	9397	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306911383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARJA KAAKKO

Provider Business Mailing Address
First Line	:	700 NW GILMAN BLVD
Second Line	:	SUITE E-103, #493
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-5395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 NW GILMAN BLVD
Second Line	:	SUITE E-103, #493
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-5395
Country	:	US
Telephone Number	:	206-355-1596
Fax Number	:	425-369-9785

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/11/2008

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Directions to “ TARJA KAAKKO ” Practice Location

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