Provider Demographics
NPI:1407830441
Name:KANJO, ZAYAN ANIS (MD)
Entity type:Individual
Prefix:MR
First Name:ZAYAN
Middle Name:ANIS
Last Name:KANJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SE BARRINGTON DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277
Mailing Address - Country:US
Mailing Address - Phone:360-679-3161
Mailing Address - Fax:360-679-1741
Practice Address - Street 1:231 SE BARRINGTON DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-679-3161
Practice Address - Fax:360-679-1741
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110130199OtherRAILROAD MEDICARE
WA52525OtherBLUE CROSS/SHIELD
S57923OtherBLUE CROSS/SHIELD
WA110130199OtherRAILROAD MEDICARE