Provider Demographics
NPI:1568571826
Name:MEHTA, AMI DHARMESH (MD)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:DHARMESH
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:CHANDRA
Other - Last Name:VORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13030 121ST WAY NE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:KIRLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13030 121ST WAY NE
Practice Address - Street 2:SUITE #100
Practice Address - City:KIRLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-814-5170
Practice Address - Fax:425-823-5826
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60075514208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics