Healthcare Provider Details

I. General information

NPI: 1912072885
Provider Name (Legal Business Name): ODETTE TAMIKO SUEDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 37TH AVE S
SEATTLE WA
98118-1609
US

IV. Provider business mailing address

19306 63RD AVE NE
KENMORE WA
98028-3353
US

V. Phone/Fax

Practice location:
  • Phone: 206-296-4650
  • Fax: 206-296-0580
Mailing address:
  • Phone: 425-485-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP21201
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: