Healthcare Provider Details

I. General information

NPI: 1093001810
Provider Name (Legal Business Name): AYA IWAI D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4426 168TH ST SW
LYNNWOOD WA
98037-3138
US

IV. Provider business mailing address

918 N 73RD ST
SEATTLE WA
98103-5341
US

V. Phone/Fax

Practice location:
  • Phone: 425-742-7387
  • Fax: 425-787-1065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVT60157381
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: