Healthcare Provider Details

I. General information

NPI: 1992185136
Provider Name (Legal Business Name): SAMANDIP SINGH HOTHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S STE 100
FEDERAL WAY WA
98003-8726
US

IV. Provider business mailing address

34503 9TH AVE S STE 100
FEDERAL WAY WA
98003-8726
US

V. Phone/Fax

Practice location:
  • Phone: 253-835-8700
  • Fax: 253-835-8000
Mailing address:
  • Phone: 253-835-8700
  • Fax: 253-835-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61037682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: