Provider Demographics
NPI:1003352410
Name:KAI MORIMOTO MD PLLC
Entity Type:Organization
Organization Name:KAI MORIMOTO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-315-4415
Mailing Address - Street 1:12615 E MISSION AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-3060
Mailing Address - Country:US
Mailing Address - Phone:509-315-4415
Mailing Address - Fax:509-315-8304
Practice Address - Street 1:12615 E MISSION AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3060
Practice Address - Country:US
Practice Address - Phone:509-315-4415
Practice Address - Fax:509-315-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036729208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty