Provider Demographics
NPI:1346395787
Name:IKAI, SUE ANN (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:IKAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 S DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2124
Mailing Address - Country:US
Mailing Address - Phone:206-890-3363
Mailing Address - Fax:206-466-2327
Practice Address - Street 1:5200 S DAWSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2124
Practice Address - Country:US
Practice Address - Phone:206-890-3363
Practice Address - Fax:206-466-2327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB14163Medicare ID - Type Unspecified
E95614Medicare UPIN