Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DE00002856 | WA |
Y | 213EG0000X | General Practice | DE00002856 | WA |
NPI | 1003936733 |
---|---|
Provider Name | Fred Isamu Hasegawa |
First Address | Seattle, WA 98118-1657 |
Second Address | Seattle, WA 98118-1657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |