Provider Demographics
NPI:1902001605
Name:TIKHONOV, RIMMA M (LMP)
Entity Type:Individual
Prefix:
First Name:RIMMA
Middle Name:M
Last Name:TIKHONOV
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 BEL RED RD STE B11
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2322
Mailing Address - Country:US
Mailing Address - Phone:425-746-3315
Mailing Address - Fax:425-644-2800
Practice Address - Street 1:13401 BEL RED RD STE B11
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2322
Practice Address - Country:US
Practice Address - Phone:425-746-3315
Practice Address - Fax:425-644-2800
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00006780OtherLMP