Provider Demographics
NPI:1881845907
Name:NORTH PACIFIC DERMATOLOGY PS
Entity Type:Organization
Organization Name:NORTH PACIFIC DERMATOLOGY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOBUYOSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGEYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-264-0660
Mailing Address - Street 1:1200 112TH AVE NE
Mailing Address - Street 2:STE C187
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3732
Mailing Address - Country:US
Mailing Address - Phone:425-457-7900
Mailing Address - Fax:425-264-0601
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:STE 205
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:425-264-0660
Practice Address - Fax:425-264-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical