Provider Demographics
NPI:1548084205
Name:KOJIMA, KHALIFAH IMAN
Entity type:Individual
Prefix:
First Name:KHALIFAH
Middle Name:IMAN
Last Name:KOJIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KHALIFAH
Other - Middle Name:IMAN
Other - Last Name:WHITNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16080 NE 85TH ST APT 416
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3570
Mailing Address - Country:US
Mailing Address - Phone:313-452-0154
Mailing Address - Fax:
Practice Address - Street 1:11410 NE 122ND WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6945
Practice Address - Country:US
Practice Address - Phone:425-650-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator