Organization
NORTH PACIFIC DERMATOLOGY SERVICES, LLC
Active
Other names
North Pacific Dermatology, P.S.
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE P KAGEYAMA M.D. (PRESIDENT)
(425) 264-0660
Entity
Organization
Contact information
Practice address
1412 SW 43RD ST STE 205, RENTON, WA 98057-4803
(425) 264-0660
(425) 264-0601
Mailing address
1412 SW 43RD ST STE 205, RENTON, WA 98057-4803
(425) 264-0660
(425) 264-0601
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD00046078
WA
207ND0900X
Dermatopathology Physician
MTS-4912
WA
261QA1903X
Ambulatory Surgical Clinic/Center
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE5794
RAILROAD MEDICARE
WA
Enumeration date
10/09/2007
Last updated
01/11/2010
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