Provider Demographics
NPI:1316073489
Name:ZASIMOVA, IRINA V (LAC, MD, PHD)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:V
Last Name:ZASIMOVA
Suffix:
Gender:F
Credentials:LAC, MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 SE 79TH DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-9200
Mailing Address - Country:US
Mailing Address - Phone:425-753-4754
Mailing Address - Fax:
Practice Address - Street 1:606 120TH AVE NE
Practice Address - Street 2:STE. D-104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3026
Practice Address - Country:US
Practice Address - Phone:425-455-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 00002555171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist