KEN KOYANAGAWA (DO) – Emergency Medicine Physician, NPI 1225603053
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
111 GENERAL PRACTICE in WA
Provider Addresses for KEN KOYANAGAWA (DO)
450 S Kitsap Blvd Ste 100
Port Orchard, WA 983663709
Phone: (360) 895-7620
Fax: (360) 895-7638
Type: Location
4205 KITSAP WAY
BREMERTON, WA 983122447
Phone: (360) 782-7780
Fax: (360) 782-7789
Type: Mailing
121 DEKALB AVE
BROOKLYN, NY 112015425
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-08-11
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250717001053 | I | General Practice | NY | TBD |
| I20250811002691 | I | Emergency Medicine | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 98366)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | NY | |
| Physician Assistant | NY | |
| Physician Assistant | NY | |
| Family Practice | NY | |
| Nurse Practitioner | NY | |
| Physician Assistant | NY | |
| Physician Assistant | NY | |
| Nurse Practitioner | NY | |
| - | NY | |
| Physician Assistant | NY |
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