Active NPI
James Michael Kozik, D.D.S
- Dentist
- Walla Walla, WA
National Provider Identifier
1396985677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00010974
- Practice address
- 77 Wainwright Dr
Walla Walla, WA 99362-3975 - Phone
- (707) 972-6100
- NPI assigned
- Feb 26, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE00010974 | WA | Primary |
Addresses
Primary practice location
77 Wainwright Dr
Walla Walla, WA 99362-3975
Mailing address
1077 SE Crestlane Dr
College Place, WA 99324-1379
Phone (509) 525-3216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00010974 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235606400000",
"number": "1396985677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1077 SE CRESTLANE DR",
"city": "COLLEGE PLACE",
"state": "WA",
"postal_code": "993241379",
"telephone_number": "509-525-3216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 WAINWRIGHT DR",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993623975",
"telephone_number": "707-972-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOZIK",
"first_name": "JAMES",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-26",
"last_updated": "2009-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00010974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.