Provider Demographics
NPI:1679561427
Name:KAGEYAMA, NOBUYOSHI (M D)
Entity type:Individual
Prefix:DR
First Name:NOBUYOSHI
Middle Name:
Last Name:KAGEYAMA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 112TH AVE NE STE C187
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3749
Mailing Address - Country:US
Mailing Address - Phone:425-457-7900
Mailing Address - Fax:425-457-7499
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:425-264-0660
Practice Address - Fax:425-264-0601
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4999207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457582Medicaid
WAP00341277OtherRAILROAD MC #
WA0715KAOtherBLUE SHIELD #
WAUS7949137OtherATENA SPECIALIST PIN
WAP00341277OtherRAILROAD MC #
WAH13355Medicare UPIN