Provider Demographics
NPI:1639296494
Name:YASUDA, GREGORY (ND)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:YASUDA
Suffix:
Gender:M
Credentials:ND
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 94205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6505
Mailing Address - Country:US
Mailing Address - Phone:206-834-4100
Mailing Address - Fax:206-834-4131
Practice Address - Street 1:3670 STONE WAY N STE N271
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8004
Practice Address - Country:US
Practice Address - Phone:206-834-4100
Practice Address - Fax:206-834-4131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT1237175F00000X
WANT00001237175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035036Medicaid