Healthcare Provider Details

I. General information

NPI: 1942246293
Provider Name (Legal Business Name): DMITRI V VASIN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 NW MYHRE RD SUITE 220
SILVERDALE WA
98383
US

IV. Provider business mailing address

2021 NW MYHRE RD SUITE 220
SILVERDALE WA
98383
US

V. Phone/Fax

Practice location:
  • Phone: 360-613-0600
  • Fax: 360-613-0603
Mailing address:
  • Phone: 360-613-0600
  • Fax: 360-613-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD00038345
License Number StateWA

VIII. Authorized Official

Name: KIMBERLY A HANSEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 360-613-0600