MEDICARE: DR. NOBUYOSHI KAGEYAMA M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	L4999	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00341277	OTHER	WA	RAILROAD MC #
3	0715KA	OTHER	WA	BLUE SHIELD #
4	US7949137	OTHER	WA	ATENA SPECIALIST PIN

General Provider Information

NPI Number	:	1679561427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOBUYOSHI KAGEYAMA M. D.

Provider Business Mailing Address
First Line	:	1200 112TH AVE NE STE C187
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3749
Country	:	US
Telephone Number	:	425-457-7900
Fax Number	:	425-457-7499

Provider Business Practice Location Address
First Line	:	1412 SW 43RD ST
Second Line	:	SUITE 205
City	:	RENTON
State	:	WA
Zip	:	98057-4803
Country	:	US
Telephone Number	:	425-264-0660
Fax Number	:	425-264-0601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/21/2022

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