Provider Demographics
NPI:1245558972
Name:CHAKHALIDZE, AYDIN ALIMOVICH
Entity Type:Individual
Prefix:
First Name:AYDIN
Middle Name:ALIMOVICH
Last Name:CHAKHALIDZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14239 S 34TH AVE #301
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168
Mailing Address - Country:US
Mailing Address - Phone:206-218-2972
Mailing Address - Fax:
Practice Address - Street 1:15245 INTERNATIONAL BLVD. SUITE 210
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-923-7600
Practice Address - Fax:206-923-7601
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60141116172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker