Basic Information
| Provider Information | |||||||||
| NPI: | 1639606924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWATRA | ||||||||
| FirstName: | SHIVANI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 STEWART ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8334115469 | ||||||||
| FaxNumber: | 8554593020 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 STEWART ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8334115469 | ||||||||
| FaxNumber: | 8554593020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2017 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD61227461 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.