Healthcare Provider Details

I. General information

NPI: 1033276928
Provider Name (Legal Business Name): YOSHINARI NAKAYAMA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YOSHINARI NAKAYAMA DDS

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S 320TH ST
FEDERAL WAY WA
98003-5400
US

IV. Provider business mailing address

5007 NORPOINT WAY NE
TACOMA WA
98422-4272
US

V. Phone/Fax

Practice location:
  • Phone: 206-400-0800
  • Fax:
Mailing address:
  • Phone: 253-952-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00005461
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: