Healthcare Provider Details

I. General information

NPI: 1124983291
Provider Name (Legal Business Name): ESUBALEW MINDAYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 RIMLAND DR STE 301
BELLINGHAM WA
98226-8759
US

IV. Provider business mailing address

22692 129TH PL SE
KENT WA
98031-3978
US

V. Phone/Fax

Practice location:
  • Phone: 832-776-3603
  • Fax:
Mailing address:
  • Phone: 301-250-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDCE.ML.70053971
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: