Healthcare Provider Details

I. General information

NPI: 1942509724
Provider Name (Legal Business Name): DENSEY MATTHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 164TH STREET SE SUITE 100
MILL CREEK WA
98012
US

IV. Provider business mailing address

805 164TH STREET SE SUITE 100
MILL CREEK WA
98012
US

V. Phone/Fax

Practice location:
  • Phone: 425-354-4296
  • Fax: 425-332-3495
Mailing address:
  • Phone: 405-271-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-37283
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34323
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61344550
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: