Healthcare Provider Details

I. General information

NPI: 1255953113
Provider Name (Legal Business Name): DARRYN HIROSHI MATSUSHIMA RDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 167TH PL SW
BOTHELL WA
98012-5967
US

IV. Provider business mailing address

105 167TH PL SW
BOTHELL WA
98012-5967
US

V. Phone/Fax

Practice location:
  • Phone: 503-803-9866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number99187
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: