Provider Demographics
NPI:1396005567
Name:DR. ANANDHI MANDI LLC
Entity Type:Organization
Organization Name:DR. ANANDHI MANDI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-690-4308
Mailing Address - Street 1:PO BOX 97115
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98497-0115
Mailing Address - Country:US
Mailing Address - Phone:253-588-7911
Mailing Address - Fax:253-984-6774
Practice Address - Street 1:4950 NE BELKNAP CT
Practice Address - Street 2:SUITE # 202
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5113
Practice Address - Country:US
Practice Address - Phone:503-690-4308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD22450OtherPROFESSIONAL LICENSE