Provider Demographics
NPI:1932213261
Name:NIAKAN, ENAYAT (MD)
Entity type:Individual
Prefix:
First Name:ENAYAT
Middle Name:
Last Name:NIAKAN
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 1:2720 CLARE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3374
Mailing Address - Country:US
Mailing Address - Phone:360-377-9079
Mailing Address - Fax:360-377-3262
Practice Address - Street 1:2720 CLARE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3374
Practice Address - Country:US
Practice Address - Phone:360-377-9079
Practice Address - Fax:360-377-3262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25122204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000200613Medicare ID - Type Unspecified
WAE33814Medicare UPIN