Provider Demographics
NPI:1841896958
Name:IDRISADEM, YOSIEF M
Entity type:Individual
Prefix:
First Name:YOSIEF
Middle Name:M
Last Name:IDRISADEM
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 1:7213 196TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4418
Mailing Address - Country:US
Mailing Address - Phone:206-787-2861
Mailing Address - Fax:
Practice Address - Street 1:7213 196TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4418
Practice Address - Country:US
Practice Address - Phone:206-787-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603309439171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter