=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306165063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBIKA BIJUKCHHE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2010
-----------------------------------------------------
Last Update Date | 05/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 NE MOTHER JOSEPH PLACE SOUTHWEST WASHINGTON MEDICAL CENTER
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-514-3764
-----------------------------------------------------
Fax | 360-514-2289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 HEGEMAN AVE APT # 14 D
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11212-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-405-9961
-----------------------------------------------------
Fax | 347-405-9961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 60147871
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 60147871
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------