Provider Demographics
NPI:1285217158
Name:CHAMBERS BAY INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CHAMBERS BAY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:NIAMATALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-353-2087
Mailing Address - Street 1:8307 63RD STREET CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8307 63RD STREET CT W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3951
Practice Address - Country:US
Practice Address - Phone:253-353-2087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty