Healthcare Provider Details

I. General information

NPI: 1699077263
Provider Name (Legal Business Name): BHUPESH RATHOD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BATTERSBY AVE
ENUMCLAW WA
98022
US

IV. Provider business mailing address

PO BOX 31001-1518
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6341
  • Fax: 253-426-6344
Mailing address:
  • Phone: 253-779-6260
  • Fax: 253-779-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-097132
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60332000
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-097132
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60332000
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7100167000
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer
# 2
Identifier201023160
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 3
Identifier2029557
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier3149060
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: