Provider Demographics
NPI:1215011929
Name:TERASAKI, WESLEY L (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:L
Last Name:TERASAKI
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:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:425-641-4000
Mailing Address - Fax:
Practice Address - Street 1:12917 SE 38TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1349
Practice Address - Country:US
Practice Address - Phone:425-641-4000
Practice Address - Fax:206-320-5840
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1050129Medicaid
WAAB07855Medicare PIN
WA1050129Medicaid