Healthcare Provider Details

I. General information

NPI: 1497029177
Provider Name (Legal Business Name): MELYSSA MIYAKO JOHNSON GALLOWAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELYSSA M JOHNSON

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE # LL140
BELLEVUE WA
98004-4623
US

IV. Provider business mailing address

1135 116TH AVE NE # LL140
BELLEVUE WA
98004-4623
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-5000
  • Fax: 425-688-5009
Mailing address:
  • Phone: 425-688-5000
  • Fax: 425-688-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60969397
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60969397
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: