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NPI Code Detail

MEDICARE: DR. MIYUKI TOMURA PHD

MEDICARE: DR. MIYUKI TOMURA PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY60257713WA
2101YM0800XMental Health CounselorMHC-899-0HI

General Provider Information

NPI Number : 1710163308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIYUKI TOMURA PHD
Provider Business Mailing Address
First Line : 3035 ISLAND CREST WAY
Second Line : SUITE 108
City : MERCER ISLAND
State : WA
Zip : 98040-2919
Country : US
Telephone Number : 425-677-4146
Fax Number :
Provider Business Practice Location Address
First Line : 3639 MARTIN LUTHER KING JR WAY S
Second Line :
City : SEATTLE
State : WA
Zip : 98144-6847
Country : US
Telephone Number : 206-805-8965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2008
Last Update Date : 04/26/2023

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