Konikkara, John Joseph

Konikkara, John Joseph is an sole proprietor health care provider with primary practice located at 1615 Delaware St , Longview WA 98632-2367. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Sleep Medicine. Allopathic & Osteopathic Physicians / Sleep Medicine is his primary health care specialty. Konikkara, John Joseph can be contacted via phone (360) 414-7800.

Contact Information

Primary practice address
1615 Delaware St Longview WA 98632-2367
Phone: (360) 414-7800
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X MD60704069 Washington
Allopathic & Osteopathic Physicians / Neurology 2084N0400X MD60704069 Washington
Allopathic & Osteopathic Physicians / Sleep Medicine 2084S0012X MD60704069 Washington

Profile Details

NPI number 1962664011
LBN Legal business name Konikkara, John Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 30th, 2008
Last updated Apr 10th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962664011 NPPES
Washington MEDICAID 2070508

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