1679561427 NPI number — DR. NOBUYOSHI KAGEYAMA M. D.

Table of content: DR. NOBUYOSHI KAGEYAMA M. D. (NPI 1679561427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679561427 NPI number — DR. NOBUYOSHI KAGEYAMA M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAGEYAMA
Provider First Name:
NOBUYOSHI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679561427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 112TH AVE NE STE C187
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-3749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-457-7900
Provider Business Mailing Address Fax Number:
425-457-7499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1412 SW 43RD ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-264-0660
Provider Business Practice Location Address Fax Number:
425-264-0601
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  L4999 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8457582 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00341277 . This is a "RAILROAD MC #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0715KA . This is a "BLUE SHIELD #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US7949137 . This is a "ATENA SPECIALIST PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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