Healthcare Provider Details

I. General information

NPI: 1679486286
Provider Name (Legal Business Name): EMIKO KISHIBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16398 NE 85TH ST STE 100
REDMOND WA
98052-3555
US

IV. Provider business mailing address

2611 S 240TH ST APT D
DES MOINES WA
98198-2725
US

V. Phone/Fax

Practice location:
  • Phone: 425-636-1569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.61578208
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: