Provider Demographics
NPI:1790015766
Name:KAHIRIMBANYI, PERESI KAMAZOOB (MD)
Entity Type:Individual
Prefix:DR
First Name:PERESI
Middle Name:KAMAZOOB
Last Name:KAHIRIMBANYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:520 N 4TH AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5257
Mailing Address - Country:US
Mailing Address - Phone:509-416-8849
Mailing Address - Fax:509-542-3059
Practice Address - Street 1:7425 WRIGLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5292
Practice Address - Country:US
Practice Address - Phone:509-416-8888
Practice Address - Fax:509-545-6842
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25754207Q00000X
WAMD 60193720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8903316Medicare UPIN