Provider Demographics
NPI:1437473451
Name:CHAWLA, KAVITA PRABHJYOTSINGH (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:PRABHJYOTSINGH
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 NE 128TH ST STE 300
Mailing Address - Street 2:MS; A-ME
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7211
Mailing Address - Country:US
Mailing Address - Phone:425-821-8004
Mailing Address - Fax:425-820-9860
Practice Address - Street 1:11800 NE 128TH ST STE 300
Practice Address - Street 2:MS; A-ME
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7211
Practice Address - Country:US
Practice Address - Phone:425-821-8004
Practice Address - Fax:425-820-9860
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60385623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8921389Medicare PIN
WAG8921391Medicare PIN
WAG8921390Medicare PIN