Basic Information
| Provider Information | |||||||||
| NPI: | 1326334491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOUDHRY | ||||||||
| FirstName: | AISHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 S J ST STE 2120 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535347000 | ||||||||
| FaxNumber: | 3607823115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 S J ST STE 2120 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535347000 | ||||||||
| FaxNumber: | 3607823115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | 60650131 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 390200000X | R - 9301 | IA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2081H0002X | MD60650131 | WA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2068052 | 05 | WA | MEDICAID |