Provider Demographics
NPI:1851900427
Name:TANJI, KOICHI
Entity Type:Individual
Prefix:
First Name:KOICHI
Middle Name:
Last Name:TANJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 NE 15TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3719
Mailing Address - Country:US
Mailing Address - Phone:206-201-4087
Mailing Address - Fax:833-914-2737
Practice Address - Street 1:11226 NE 15TH ST STE 6
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3719
Practice Address - Country:US
Practice Address - Phone:206-201-4087
Practice Address - Fax:833-914-2737
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61219790175F00000X
WALH61441809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175F00000XOther Service ProvidersNaturopath