Provider Demographics
NPI:1013296771
Name:KODLIPET JAGADEESH, KAVYASHRI (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVYASHRI
Middle Name:
Last Name:KODLIPET JAGADEESH
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:1330 ROCKEFELLER AVE STE 210
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1676
Practice Address - Country:US
Practice Address - Phone:425-261-4940
Practice Address - Fax:425-261-4932
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61170649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine