Provider Demographics
NPI:1295429173
Name:KAYAHARA, TRAVIS TERU
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:TERU
Last Name:KAYAHARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14908 SE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-2408
Mailing Address - Country:US
Mailing Address - Phone:425-891-3588
Mailing Address - Fax:
Practice Address - Street 1:14908 SE 43RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-2408
Practice Address - Country:US
Practice Address - Phone:425-891-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program