Provider Demographics
NPI:1053412098
Name:HIRAI, SATOMI (DPD)
Entity type:Individual
Prefix:MS
First Name:SATOMI
Middle Name:
Last Name:HIRAI
Suffix:
Gender:F
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10137 MAIN ST
Mailing Address - Street 2:SUIT 7
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3422
Mailing Address - Country:US
Mailing Address - Phone:425-483-4643
Mailing Address - Fax:425-483-1493
Practice Address - Street 1:10137 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3422
Practice Address - Country:US
Practice Address - Phone:425-483-4643
Practice Address - Fax:425-483-1493
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0000258122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8029423Medicaid
WA5036835Medicaid