Healthcare Provider Details

I. General information

NPI: 1659754901
Provider Name (Legal Business Name): BEKA BAKHTADZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NW MYHRE RD FL 3
SILVERDALE WA
98383-7662
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 564-240-4200
  • Fax: 564-240-4299
Mailing address:
  • Phone: 678-358-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.MD.61659167
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD.MD.61659167
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: