John Joseph Konikkara, MD

Primary specialty

Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X

License

MD60704069 Issued in WA

Practice address

1615 Delaware St
Longview, WA 98632-2367

Phone

(360) 414-7800

NPI assigned

Jun 30, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491782400000",
    "number": "1962664011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8157 SOUTHWESTERN BLVD",
            "address_2": "APARTMENT# 142",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752062019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-414-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONIKKARA",
        "first_name": "JOHN JOSEPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2017-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD60704069",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD60704069",
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "WA",
            "license": "MD60704069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2070508",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Renee Knotts, PHARMD
• Stephanie Koehler, CAAR
• Richard Koethke, MS, LMHC, MHP
• Chelcie M Kolaski, CDP
• Venkata Prashanthi Konda, MD
• Joanne E Kooistra
• Debra L Koreis
• Eric Koreis, MS, EMT-P
• Debra Perko Kornberg, M.S.
• Joanie M Korpi-Link, LMP

• Sleep Medicine (Psychiatry & Neurology) Physician in Longview, WA
• Providers in Longview, WA by specialty
• Sleep Medicine (Psychiatry & Neurology) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.