Healthcare Provider Details

I. General information

NPI: 1326052671
Provider Name (Legal Business Name): TANYA A WAHL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 NE BLAKELY DR STE 2030
ISSAQUAH WA
98029-6201
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-4200
  • Fax: 425-313-4201
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD00039965
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: