Provider Demographics
NPI:1497843213
Name:KOIKE, VINCENT M (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:M
Last Name:KOIKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14517 62ND DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9391
Mailing Address - Country:US
Mailing Address - Phone:425-337-5042
Mailing Address - Fax:
Practice Address - Street 1:7601 EVERGREEN WAY, B-6
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203
Practice Address - Country:US
Practice Address - Phone:425-353-9191
Practice Address - Fax:425-353-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE53794Medicare UPIN