Healthcare Provider Details

I. General information

NPI: 1477047785
Provider Name (Legal Business Name): KANIKA CHAWLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SWIFT BLVD STE 101
RICHLAND WA
99352-3545
US

IV. Provider business mailing address

PO BOX 19638
SPRINGFIELD IL
62794-9638
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3060
  • Fax: 509-946-1850
Mailing address:
  • Phone: 217-545-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61633200
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125072908
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD61633200
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: