Basic Information
| Provider Information | |||||||||
| NPI: | 1447631684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJ | ||||||||
| FirstName: | VIVEK | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6721 ELAINE CT SE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980928350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195971118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 S VASSAULT ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984652008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534443320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2015 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OP61113387 | WA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 34.013937 | OH | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.