Provider Demographics
NPI:1336159938
Name:KODNER, DANIEL AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:AARON
Last Name:KODNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4742 42ND AVE SW # 412
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4553
Mailing Address - Country:US
Mailing Address - Phone:206-552-0312
Mailing Address - Fax:206-338-9960
Practice Address - Street 1:6707 35TH PL S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-6454
Practice Address - Country:US
Practice Address - Phone:206-552-0312
Practice Address - Fax:206-338-9960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC525002084P0800X
NV118022084P0800X
WAMD000361162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG70093Medicare UPIN