Basic Information
| Provider Information | |||||||||
| NPI: | 1467420174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAWANDI | ||||||||
| FirstName: | WASSIM | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 GAGE BLVD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993529532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423627 | ||||||||
| FaxNumber: | 5096272983 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 N COLORADO ST STE A | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993367845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423156 | ||||||||
| FaxNumber: | 5097356998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00043231 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD24992 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD00043231 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 0258390 | 01 | WA | LABOR & INDUSTRIES | OTHER | 8415689 | 05 | WA | MEDICAID | 277863 | 05 | OR | MEDICAID | R130644 | 01 | OR | GROUP MEDICARE PIN | OTHER | G8851019 | 01 | WA | GROUP MEDICARE PIN | OTHER |