Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD60690764 | WA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD60690764 | WA |
NPI | 1205021961 |
---|---|
Provider Name | Dr. Omar Chikovani |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-4379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 24/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205021961 | (05) | WA |