Individual
MARK KODAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2205 W LINCOLN AVE, YAKIMA, WA 98902-2437
(509) 575-3399
(509) 575-3397
Mailing address
PO BOX 190, TOPPENISH, WA 98948-0190
(509) 865-6175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00007360
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44528
L & I
WA
01
—
5006077
CHPW
WA
05
—
5006077
—
WA
Enumeration date
10/03/2006
Last updated
07/08/2007
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