Healthcare Provider Details

I. General information

NPI: 1750738860
Provider Name (Legal Business Name): DEEPTHI KODALI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N VERCLER RD
SPOKANE VALLEY WA
99216-1020
US

IV. Provider business mailing address

24373 E HARRIER LOOP
LIBERTY LAKE WA
99019-5400
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-1000
  • Fax:
Mailing address:
  • Phone: 304-993-9323
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD61351890
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD61351890
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: