Provider Demographics
NPI:1124096649
Name:INOUYE, THEODORE KOICHI (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:KOICHI
Last Name:INOUYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34509 9TH AVE S
Mailing Address - Street 2:STE 208
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8709
Mailing Address - Country:US
Mailing Address - Phone:253-944-3278
Mailing Address - Fax:253-944-4345
Practice Address - Street 1:34509 9TH AVE S
Practice Address - Street 2:STE 208
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8709
Practice Address - Country:US
Practice Address - Phone:253-944-3278
Practice Address - Fax:253-944-4345
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022785208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0246067OtherSTATE L&I
WA1005073Medicaid
WA8950424OtherCRIME VICTIMS
WA8536526Medicaid
WAG8879362OtherMEDICARE
WAG8879361OtherMEDICARE
WA0246081OtherL & I
WA8536534Medicaid
WA8536526Medicaid
WA0246081OtherL & I