Provider Demographics
NPI:1104954759
Name:KITADA, MASAKO (EAMP, LAC, DIOM)
Entity type:Individual
Prefix:
First Name:MASAKO
Middle Name:
Last Name:KITADA
Suffix:
Gender:F
Credentials:EAMP, LAC, DIOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 SE 1ST STREET SUITE 202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-577-8074
Mailing Address - Fax:425-455-0346
Practice Address - Street 1:11671 SE 1ST STREET SUITE202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-577-8074
Practice Address - Fax:425-455-0346
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60162207171100000X
CAAC11198171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-5042985OtherTAX ID