Provider Demographics
NPI:1912360272
Name:KOHN, MARK DANIEL (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DANIEL
Last Name:KOHN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE STE G10
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3048
Mailing Address - Country:US
Mailing Address - Phone:425-823-4000
Mailing Address - Fax:425-821-3550
Practice Address - Street 1:12911 120TH AVE NE STE H210
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3065
Practice Address - Country:US
Practice Address - Phone:425-823-4000
Practice Address - Fax:425-821-3550
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61191259207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2060060Medicaid
WA509100OtherWA LABOR & INDUSTRIES