Healthcare Provider Details

I. General information

NPI: 1508020801
Provider Name (Legal Business Name): KAMAL RAJ JOSHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LILLY RD NE STE 100
OLYMPIA WA
98506-5195
US

IV. Provider business mailing address

500 LILLY RD NE STE 100
OLYMPIA WA
98506-5195
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8525
  • Fax: 360-412-6477
Mailing address:
  • Phone: 360-413-8525
  • Fax: 360-412-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD61182966
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35133993
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD450201
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35133993
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD61182966
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: