Provider Demographics
NPI:1073645230
Name:DIMBIL, MUMIN DAUD (MD)
Entity Type:Individual
Prefix:
First Name:MUMIN
Middle Name:DAUD
Last Name:DIMBIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22000 MARINE VIEW DR S STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6233
Mailing Address - Country:US
Mailing Address - Phone:206-870-4460
Mailing Address - Fax:206-870-4770
Practice Address - Street 1:22000 MARINE VIEW DR S STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6233
Practice Address - Country:US
Practice Address - Phone:206-870-4460
Practice Address - Fax:206-870-4770
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1042758Medicaid