Provider Demographics
NPI:1467420174
Name:KHAWANDI, WASSIM A (MD)
Entity Type:Individual
Prefix:MR
First Name:WASSIM
Middle Name:A
Last Name:KHAWANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:510 N COLORADO ST STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7845
Practice Address - Country:US
Practice Address - Phone:509-942-3156
Practice Address - Fax:509-735-6998
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043231207R00000X, 207RN0300X
ORMD24992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0258390OtherLABOR & INDUSTRIES
WA8415689Medicaid
OR277863Medicaid
ORR130644OtherGROUP MEDICARE PIN
WAG8851019OtherGROUP MEDICARE PIN
WAG8850810Medicare PIN
WAG8851019OtherGROUP MEDICARE PIN
WA8415689Medicaid
OR277863Medicaid