Provider Demographics
NPI:1184743809
Name:KENT, DANIEL L (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:KENT
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 1:8465 SE 83RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5646
Mailing Address - Country:US
Mailing Address - Phone:206-369-4263
Mailing Address - Fax:206-232-1102
Practice Address - Street 1:8465 SE 83RD ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-5646
Practice Address - Country:US
Practice Address - Phone:206-232-7649
Practice Address - Fax:206-232-1102
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8149387Medicaid
WA8149387Medicaid