Provider Demographics
NPI:1447123120
Name:KOSO, TESORO LUIS
Entity type:Individual
Prefix:
First Name:TESORO
Middle Name:LUIS
Last Name:KOSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22611 112TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2656
Mailing Address - Country:US
Mailing Address - Phone:253-217-6850
Mailing Address - Fax:253-217-6850
Practice Address - Street 1:30818 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4902
Practice Address - Country:US
Practice Address - Phone:253-217-6850
Practice Address - Fax:253-839-1505
Is Sole Proprietor?:No
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61459879122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist