Provider Demographics
NPI:1669537411
Name:TAKEMURA, KENNETH K (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:K
Last Name:TAKEMURA
Suffix:
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 1:330 SW 43RD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4900
Mailing Address - Country:US
Mailing Address - Phone:425-251-9900
Mailing Address - Fax:425-251-9909
Practice Address - Street 1:330 SW 43RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4900
Practice Address - Country:US
Practice Address - Phone:425-251-9900
Practice Address - Fax:425-251-9909
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD41579208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2763TAOtherREGENCE BLUESHIELD
WA8867800Medicare PIN
WA8850571Medicare ID - Type Unspecified
WAG86354Medicare UPIN