Provider Demographics
NPI:1407956394
Name:KANESHIRO, NEIL K (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:K
Last Name:KANESHIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17000 140TH AVE NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:425-483-5437
Mailing Address - Fax:425-488-4919
Practice Address - Street 1:17000 140TH AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-483-5437
Practice Address - Fax:425-488-4919
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD32047208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7160179Medicaid