Provider Demographics
NPI:1811984842
Name:HAYASHI, RICHARD ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:HAYASHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25403 104TH AVE SE
Mailing Address - Street 2:STE 5
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6854
Mailing Address - Country:US
Mailing Address - Phone:253-854-7100
Mailing Address - Fax:253-854-7100
Practice Address - Street 1:25403 104TH AVE SE
Practice Address - Street 2:STE 5
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6854
Practice Address - Country:US
Practice Address - Phone:253-854-7100
Practice Address - Fax:253-854-7100
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA47471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5449OtherWDS
WA5544903Medicaid