Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 22471 | TX |
N | 213EG0000X | General Practice | 22471 | TX |
Y | 1223P0300X | Periodontist | 22471 | TX |
NPI | 1154681385 |
---|---|
Provider Name | Dr. Stephan Antonius Kohnen |
First Address | Bellevue, WA 98004-3718 |
Second Address | Bellevue, WA 98004-3718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 27/04/2020 |