Healthcare Provider Details

I. General information

NPI: 1821856063
Provider Name (Legal Business Name): YEVGENIY ZHIVOTOVSKIY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 N SARATOGA STREET
APO AA
98278-8800
US

IV. Provider business mailing address

3475 N SARATOGA STREET
APO AA
98278-8800
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9972
  • Fax:
Mailing address:
  • Phone: 360-257-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102209576
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: