Provider Demographics
NPI:1043235872
Name:AJUDIA, DHIREN N (MD)
Entity Type:Individual
Prefix:DR
First Name:DHIREN
Middle Name:N
Last Name:AJUDIA
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 1:148 PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-1719
Mailing Address - Country:US
Mailing Address - Phone:425-255-0055
Mailing Address - Fax:
Practice Address - Street 1:148 PARK AVE N
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-1719
Practice Address - Country:US
Practice Address - Phone:425-255-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD22406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010248Medicaid
WA1010248Medicaid
WAG000100065Medicare ID - Type UnspecifiedMEDICARE #