Provider Demographics
NPI:1245808237
Name:GREENE, BENJAMIN JOSEPH KIYOSHI (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOSEPH KIYOSHI
Last Name:GREENE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 E. 30TH AVE.
Mailing Address - Street 2:APT. 232
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203
Mailing Address - Country:US
Mailing Address - Phone:208-553-5229
Mailing Address - Fax:
Practice Address - Street 1:1303 W SUMMIT PKWY LOWR LEVEL1
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7033
Practice Address - Country:US
Practice Address - Phone:509-579-4300
Practice Address - Fax:509-317-9542
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61667154204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty