Healthcare Provider Details

I. General information

NPI: 1699230169
Provider Name (Legal Business Name): MR. SAJAL KUMAR TIWARY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET BOX 356423
SEATTLE WA
98195-1003
US

IV. Provider business mailing address

660 S EUCLID AVE, CB 8121
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-3300
  • Fax:
Mailing address:
  • Phone: 314-362-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMDRE.ML.61674596
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1699230169
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: