Basic Information
Provider Information
NPI: 1669740635
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KADAMBI
FirstName: APARNA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1708 YAKIMA AVE STE 300
Address2:  
City: TACOMA
State: WA
PostalCode: 984055309
CountryCode: US
TelephoneNumber: 2533638700
FaxNumber: 2534266344
Practice Location
Address1: 1708 YAKIMA AVE STE 300
Address2:  
City: TACOMA
State: WA
PostalCode: 984055309
CountryCode: US
TelephoneNumber: 2533638700
FaxNumber: 2534266344
Other Information
ProviderEnumerationDate: 12/06/2011
LastUpdateDate: 12/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001XMD60688941WAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
208054205WA MEDICAID


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