Healthcare Provider Details

I. General information

NPI: 1841017662
Provider Name (Legal Business Name): ANDINET DEBEBE YIRDAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S UNION AVE
TACOMA WA
98409-3317
US

IV. Provider business mailing address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-4327
  • Fax:
Mailing address:
  • Phone: 253-844-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMDCE.ML.61606739
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: