Provider Demographics
NPI:1376824367
Name:KOSAKA, JENNIFER KRISTIN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTIN
Last Name:KOSAKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 KIRKLAND WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-3422
Mailing Address - Country:US
Mailing Address - Phone:425-739-9093
Mailing Address - Fax:
Practice Address - Street 1:11250 KIRKLAND WAY STE 102
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-3422
Practice Address - Country:US
Practice Address - Phone:425-739-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60229648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist