Provider Demographics
NPI:1306502133
Name:KOKOS, MATTHEW CHRISTOPHER (MS, RD, CSOWM, EP-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:KOKOS
Suffix:
Gender:M
Credentials:MS, RD, CSOWM, EP-C
Other - Prefix:MR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:KOKOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, CSOWM, EP-C
Mailing Address - Street 1:5715 N BEMIS ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-7658
Mailing Address - Country:US
Mailing Address - Phone:919-699-1672
Mailing Address - Fax:
Practice Address - Street 1:5715 N BEMIS ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-7658
Practice Address - Country:US
Practice Address - Phone:919-699-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61246056133V00000X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered