Provider Demographics
NPI:1720246267
Name:KAVASSERI, KRIPA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIPA
Middle Name:
Last Name:KAVASSERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KRIPA
Other - Middle Name:
Other - Last Name:KRISHNAMOORTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1031 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-3925
Mailing Address - Country:US
Mailing Address - Phone:248-840-9487
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE STE 620
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4636
Practice Address - Country:US
Practice Address - Phone:425-454-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA60781963208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program