Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 57012823 | OH |
N | 111NI0900X | Internist | 57012823 | OH |
N | 207RC0200X | Critical Care Medicine | MD60330994 | WA |
Y | 207RP1001X | Pulmonary Disease | MD60330994 | WA |
NPI | 1053509976 |
---|---|
Provider Name | Rajesh Kumar Kandasamy |
First Address | Tacoma, WA 98405-5309 |
Second Address | Tacoma, WA 98405-5309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2030361 | (05) | WA |