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General NPI Number Information
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NPI Number | 1942246293
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Entity Type | Organization
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Legal Business Name | DMITRI V VASIN MD
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 840 CALLAHAN DR STE A
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 360-479-0349
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Fax | 360-479-0065
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Provider Business Mailing Address
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Address Line | 840 CALLAHAN DR STE A
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 360-479-0349
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Fax | 360-479-0065
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Authorized Official
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Title or Position | OWNER
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Name | DMITRI V VASIN
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Credential | MD
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Telephone | 360-479-0349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD00038345
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License Number State | WA
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