Provider Demographics
NPI:1306911383
Name:KAAKKO, TARJA
Entity type:Individual
Prefix:
First Name:TARJA
Middle Name:
Last Name:KAAKKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NW GILMAN BLVD
Mailing Address - Street 2:SUITE E-103, #493
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 NW GILMAN BLVD
Practice Address - Street 2:SUITE E-103, #493
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5395
Practice Address - Country:US
Practice Address - Phone:206-355-1596
Practice Address - Fax:425-369-9785
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA93971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5056239Medicaid
WA5040324Medicaid