Provider Demographics
NPI:1639253313
Name:KRISHNADASAN, BAHIRATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHIRATHAN
Middle Name:
Last Name:KRISHNADASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BAIYA
Other - Middle Name:
Other - Last Name:KRISHNADASAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1802 YAKIMA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-272-7777
Mailing Address - Fax:253-426-4142
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-272-7777
Practice Address - Fax:253-426-4142
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041594208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8431710Medicaid
WA8854423Medicare ID - Type UnspecifiedUW PHYSICIANS
WA8431710Medicaid