Provider Demographics
NPI:1780319798
Name:VANKOOTEN, KENNETH LANCE (CPC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LANCE
Last Name:VANKOOTEN
Suffix:
Gender:M
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 MORRIS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5737
Mailing Address - Country:US
Mailing Address - Phone:206-507-8383
Mailing Address - Fax:
Practice Address - Street 1:3320 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1805
Practice Address - Country:US
Practice Address - Phone:253-398-9567
Practice Address - Fax:253-999-5740
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty