Provider Demographics
NPI:1801971262
Name:KUMASAKA, BRIAN H (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:H
Last Name:KUMASAKA
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:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-4707
Practice Address - Street 1:660 SW 39TH ST
Practice Address - Street 2:STE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4912
Practice Address - Country:US
Practice Address - Phone:425-793-4707
Practice Address - Fax:425-656-4046
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027670207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5338KUOtherREGENCE
WA0153356OtherL&I
WA070015915OtherRR MEDICARE
WA8154429Medicaid
WA0153356OtherL&I
F75109Medicare UPIN