Provider Demographics
NPI:1811932460
Name:TING, ELISABETH KARTIKA (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:KARTIKA
Last Name:TING
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 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:21601 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7507
Practice Address - Country:US
Practice Address - Phone:425-640-4000
Practice Address - Fax:425-640-4931
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045582207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1811932460Medicaid
WAIJO1979OtherOTHER
WA0212577OtherLIWA
WA4635IJOtherBSWA
WA8462772Medicaid
WA3984IJOtherBSWA
WAIJO1979OtherOTHER
WA0212578OtherLIWA
WAG8862017Medicare PIN
WAP00378913Medicare PIN