Tetsuya Shirasuka, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

59447 Issued in CA

Practice address

22625 Pacific Hwy S
Des Moines, WA 98198-5110

Phone

(206) 878-5665

Fax

(206) 870-1504

NPI assigned

Mar 22, 2007

Last updated

Aug 25, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503619200000",
    "number": "1740307214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22625 PACIFIC HWY S",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981985110",
            "telephone_number": "206-878-5665",
            "fax_number": "206-870-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22625 PACIFIC HWY S",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981985110",
            "telephone_number": "206-878-5665",
            "fax_number": "206-870-1504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIRASUKA",
        "first_name": "TETSUYA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2017-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010449",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikeeta Shah, DO
• Shiva Shalbaf, PHARM.D
• Salahaddin Shamdeen, SOLE PROPRIETOR
• Jameelah Dorhosti Sheridan, LMP HHP
• Kendall C Shibuya, DO
• Wendelyn Shue
• Gurjeet K Sidhu, LMFT
• Julie Siegfried
• Silver Cliff PLLC
• Alan E. Sinner, D.C.

• General Practice Dentistry in Des Moines, WA
• Providers in Des Moines, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.