Individual
KENNETH H SHIBATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1608 S J ST, FLOOR 3, TACOMA, WA 98405-4930
(253) 274-7503
(253) 274-7993
Mailing address
1608 S J ST, FLOOR 3, TACOMA, WA 98405-4930
(253) 274-7503
(253) 274-7993
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00018056
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223687
L & I
WA
01
—
110248736
RAILROAD
WA
01
—
167254
L & I
WA
05
—
8243388
—
WA
01
—
8933459
CRIME VICTIMS
WA
Enumeration date
08/10/2006
Last updated
04/03/2014
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