Provider Demographics
NPI:1245117332
Name:USTYUGOV, PETER MAXIM
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MAXIM
Last Name:USTYUGOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 LAKE WASHINGTON BLVD S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2546
Mailing Address - Country:US
Mailing Address - Phone:206-427-0849
Mailing Address - Fax:
Practice Address - Street 1:19730 64TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5957
Practice Address - Country:US
Practice Address - Phone:206-519-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist