Healthcare Provider Details

I. General information

NPI: 1336016294
Provider Name (Legal Business Name): DEJENE ALEMAYEHU SATECHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 STATE AVE
MARYSVILLE WA
98270-2232
US

IV. Provider business mailing address

3262 LANDINGVIEW CT
LILBURN GA
30047-1404
US

V. Phone/Fax

Practice location:
  • Phone: 425-616-4100
  • Fax: 425-616-4115
Mailing address:
  • Phone: 678-207-8852
  • Fax: 678-207-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: