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General NPI Number Information
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NPI Number | 1861342602
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Entity Type | Individual
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Provider Name | AYANA MELESSE BIRHANU
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Gender | Male
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 917 PACIFIC AVE STE 600
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City | TACOMA
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State | WA
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Zip | 98402-4437
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Country | US
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Telephone | 253-232-7495
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 N SANDAL WOOD DR
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City | YORKTOWN
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State | IN
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Zip | 47396-9158
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Country | US
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Telephone | 317-457-1417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MDCE.ML.70093351
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License Number State | WA
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