Provider Demographics
NPI:1093753535
Name:TAKASUGI, BONNIE J (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:TAKASUGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34936
Mailing Address - Street 2:DEPT # 5006
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1936
Mailing Address - Country:US
Mailing Address - Phone:206-439-2988
Mailing Address - Fax:206-431-3939
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE 110
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-241-2622
Practice Address - Fax:206-241-4429
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00024354207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06142Medicare UPIN