Basic Information
| Provider Information | |||||||||
| NPI: | 1093351447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAM | ||||||||
| FirstName: | DAWDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 S GRADY WAY STE 600 | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980573227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068231004 | ||||||||
| FaxNumber: | 2063093319 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 S GRADY WAY STE 600 | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980573227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068231004 | ||||||||
| FaxNumber: | 2063093319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2019 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN60092579 | WA | N | Nursing Service Providers | Registered Nurse | 363LP2300X | AP61008322 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.