1215372313 NPI number — KENT K KUSAKABE D.D.S., P.S.

Table of content: (NPI 1215372313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215372313 NPI number — KENT K KUSAKABE D.D.S., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENT K KUSAKABE D.D.S., P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1215372313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8831 206TH ST SE APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOHOMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98296-5167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-660-4488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8435 161ST AVE NE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-660-4488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KUSAKABE
Authorized Official First Name:
KENT
Authorized Official Middle Name:
KOSHI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-660-4488

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  603288637 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5001813 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com