Provider Demographics
NPI:1033558143
Name:KUMBHAR, SACHIN SHIVAJI (MBBS, MD)
Entity Type:Individual
Prefix:MR
First Name:SACHIN
Middle Name:SHIVAJI
Last Name:KUMBHAR
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-223-6851
Mailing Address - Fax:206-344-8804
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6851
Practice Address - Fax:206-344-8804
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI675032085B0100X, 2085R0202X
WAML603878482085B0100X, 2085R0202X
WAMD611322802085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033558143Medicaid