Provider Demographics
NPI:1932393709
Name:STANLEY A. KOPP, M.D., P.S.
Entity Type:Organization
Organization Name:STANLEY A. KOPP, M.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-823-1052
Mailing Address - Street 1:PO BOX 1302
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1302
Mailing Address - Country:US
Mailing Address - Phone:425-823-1052
Mailing Address - Fax:425-899-4243
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE C-50
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-823-1052
Practice Address - Fax:425-899-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD25061207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109636Medicaid
WA0133957OtherDEPT. LABOR AND INDUSTRIE
WA0133957OtherDEPT. LABOR AND INDUSTRIE
WA1109636Medicaid