Provider Demographics
NPI:1780746172
Name:LAMBA, CHARANJIT K (MD)
Entity type:Individual
Prefix:MISS
First Name:CHARANJIT
Middle Name:K
Last Name:LAMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARANJIT
Other - Middle Name:K
Other - Last Name:BAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24703 38TH AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4111
Mailing Address - Country:US
Mailing Address - Phone:253-839-0413
Mailing Address - Fax:253-839-3685
Practice Address - Street 1:24703 38TH AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4111
Practice Address - Country:US
Practice Address - Phone:253-839-0413
Practice Address - Fax:253-839-3685
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1046994Medicaid
WAA08757Medicare UPIN
WA1046994Medicaid