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NPI Code Detail

MEDICARE: EDWARD DY M.D.

MEDICARE: EDWARD DY M.D.
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
1207R00000XInternal Medicine PhysicianMD00048928WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00524189OTHERWARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30236942OTHERWAL&I

General Provider Information

NPI Number : 1790771947
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD DY M.D.
Provider Business Mailing Address
First Line : PO BOX 50095
Second Line :
City : SEATTLE
State : WA
Zip : 98145-5095
Country : US
Telephone Number : 206-543-6420
Fax Number :
Provider Business Practice Location Address
First Line : 23213 PACIFIC HWY S
Second Line :
City : KENT
State : WA
Zip : 98032-2721
Country : US
Telephone Number : 206-870-8880
Fax Number : 206-520-1499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 09/19/2012

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