Healthcare Provider Details

I. General information

NPI: 1669898201
Provider Name (Legal Business Name): KEVIN K. GANDHI, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S UNION AVE STE 5
TACOMA WA
98405-1954
US

IV. Provider business mailing address

1530 S UNION AVE STE 5
TACOMA WA
98405-1954
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-8285
  • Fax: 253-759-3213
Mailing address:
  • Phone: 253-272-8285
  • Fax: 253-759-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD00031747
License Number StateWA

VIII. Authorized Official

Name: LYNNE R MOREY
Title or Position: MANAGER
Credential:
Phone: 253-272-8285