Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO60760414 | WA |
NPI | 1063853018 |
---|---|
Provider Name | Dr. Vinai Prakash |
First Address | Kenmore, WA 98028-4867 |
Second Address | Kenmore, WA 98028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2013 |
Last Update Date | 27/02/2019 |