Provider Demographics
NPI:1417970252
Name:MEHTA, VIVEK K (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:K
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749730
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9730
Mailing Address - Country:US
Mailing Address - Phone:206-971-0034
Mailing Address - Fax:206-215-4351
Practice Address - Street 1:1221 MADISON, 1ST FLOOR
Practice Address - Street 2:C/O SWEDISH CANCER INSTITUTE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-386-2323
Practice Address - Fax:206-215-6150
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000405262085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8298523Medicaid
H54975Medicare UPIN
WA8298523Medicaid
WAAB26959Medicare PIN