Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE603596220 | WA |
N | 1223G0001X | General Practice | DE603596220 | WA |
N | 213EG0000X | General Practice | DE603596220 | WA |
N | 1223P0300X | Periodontist | DE603596220 | WA |
NPI | 1124459599 |
---|---|
Provider Name | Mrs. Kanako J Nagatomo |
First Address | Edmonds, WA 98020-5735 |
Second Address | Edmonds, WA 98020-5735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2013 |
Last Update Date | 10/12/2013 |