Provider Demographics
NPI:1679033245
Name:BENNETT, TOMOKO (DO)
Entity type:Individual
Prefix:
First Name:TOMOKO
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 W HIGHWAY 2 STE 10
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5347
Mailing Address - Country:US
Mailing Address - Phone:509-342-3380
Mailing Address - Fax:
Practice Address - Street 1:10414 W HIGHWAY 2 STE 10
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5347
Practice Address - Country:US
Practice Address - Phone:509-342-3380
Practice Address - Fax:509-744-1711
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61305452207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program