Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | MD00048010 | WA |
NPI | 1336295864 |
---|---|
Provider Name | Dr. Kalyan Dandala |
First Address | Seattle, WA 98101-4421 |
Second Address | Bellevue, WA 98005-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 16/07/2015 |