Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DE60379151 | WA |
NPI | 1063817054 |
---|---|
Provider Name | Takafumi Otani |
First Address | Seattle, WA 98101-4117 |
Second Address | Seattle, WA 98101-4117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2014 |
Last Update Date | 03/11/2014 |