Healthcare Provider Details

I. General information

NPI: 1346346020
Provider Name (Legal Business Name): MAYA CHANDRAN KUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYA CHANDRAN M.D.

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VETERANS DR AMERICAN LAKE VAMC - PSHCS
TACOMA WA
98493-0001
US

IV. Provider business mailing address

28600 11TH AVE S
FEDERAL WAY WA
98003-3139
US

V. Phone/Fax

Practice location:
  • Phone: 253-582-8440
  • Fax: 253-589-4167
Mailing address:
  • Phone: 253-815-8206
  • Fax: 253-589-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00042051
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: