Provider Demographics
NPI:1114961315
Name:KAUKONEN, LARISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LARISA
Middle Name:A
Last Name:KAUKONEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE 50421
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:800-793-3529
Mailing Address - Fax:
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027863207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KA6997OtherREGENCE BS
WA8126674Medicaid
E98234OtherGROUP HEALTH
184572OtherWA L & I
8938306OtherWA CRIME VICTIM
8938306OtherWA CRIME VICTIM
8802602Medicare PIN
KA6997OtherREGENCE BS
G8802616Medicare PIN
E98234OtherGROUP HEALTH