Provider Demographics
NPI:1063853018
Name:PRAKASH, VINAI (DPM)
Entity type:Individual
Prefix:DR
First Name:VINAI
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 NE 181ST ST STE 4
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4867
Mailing Address - Country:US
Mailing Address - Phone:425-892-8054
Mailing Address - Fax:425-419-4379
Practice Address - Street 1:6610 NE 181ST ST STE 4
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028
Practice Address - Country:US
Practice Address - Phone:425-892-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-07
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60760414213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery