Provider Demographics
NPI:1508835273
Name:EBISU, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:EBISU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:SUITE 420
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:206-838-2590
Practice Address - Fax:206-264-8689
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-10-07
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Provider Licenses
StateLicense IDTaxonomies
WAMD00027066208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF42710Medicare UPIN
WAAB27911Medicare ID - Type Unspecified