Provider Demographics
NPI:1235321183
Name:KOK, HENDRIK S (PA C)
Entity Type:Individual
Prefix:
First Name:HENDRIK
Middle Name:S
Last Name:KOK
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BIRCHWOOD AVE
Mailing Address - Street 2:#101
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1720
Mailing Address - Country:US
Mailing Address - Phone:360-676-0922
Mailing Address - Fax:360-671-4726
Practice Address - Street 1:710 BIRCHWOOD AVE
Practice Address - Street 2:#101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1720
Practice Address - Country:US
Practice Address - Phone:360-676-0922
Practice Address - Fax:360-671-4726
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005230363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8494338Medicaid
WA0225246OtherLIWA
WA6059600 02OtherUSDLAB
WA2901KOOtherBSWA
WA8494338Medicaid
WAG8868609Medicare PIN