Matthew L Kooyman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3565 Issued in ID

Practice address

1500 W Cayuse Creek Dr Ste 100
Meridian, ID 83646-4757

Phone

(508) 884-8858

Fax

(208) 884-8915

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1699782854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 W CAYUSE CREEK DR STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836464757",
            "telephone_number": "208-884-8858",
            "fax_number": "208-884-8915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W CAYUSE CREEK DR STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836464757",
            "telephone_number": "508-884-8858",
            "fax_number": "208-884-8915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOYMAN",
        "first_name": "MATTHEW",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3565",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "D-3565",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Ryan Kohler, LPC
• Melissa Misao Komoda, PHARM D
• Eric Konkel, PA
• Gary Koopman, LPC
• Brent D. Kooy, P.A.
• Ashley Kophs
• Tracey Ann Kopperud, D.O.
• Kaley Kosak
• Anne Marie Koster, FNP
• Oleg Sergeevich Kouskov, MD

• General Practice Dentistry in Meridian, ID
• Providers in Meridian, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.