Provider Demographics
NPI:1710054044
Name:HANSEN, DAYNE D JR (MD)
Entity Type:Individual
Prefix:
First Name:DAYNE
Middle Name:D
Last Name:HANSEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:#401
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:206-431-3601
Mailing Address - Fax:206-248-7655
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:#401
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-431-3601
Practice Address - Fax:206-248-7655
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD15847207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1618107Medicaid
A04654Medicare UPIN
WA1618107Medicaid