Provider Demographics
NPI:1841229531
Name:NEPHROLOGY ASSOCIATES OF KITSAP COUNTY PLLC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF KITSAP COUNTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:COGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-377-7634
Mailing Address - Street 1:2771 HEMLOCK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2689
Mailing Address - Country:US
Mailing Address - Phone:360-377-7634
Mailing Address - Fax:360-479-6157
Practice Address - Street 1:2771 HEMLOCK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2689
Practice Address - Country:US
Practice Address - Phone:360-377-7634
Practice Address - Fax:360-479-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602421424207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE20517Medicare UPIN
WAA04284Medicare UPIN
WAG-8863689Medicare PIN
WAC15522Medicare UPIN