Basic Information
| Provider Information | |||||||||
| NPI: | 1780818518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NANDA | ||||||||
| FirstName: | KABITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 SAND POINT WAY NE # R-5420 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872057 | ||||||||
| FaxNumber: | 2069875060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE # R-5420 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872057 | ||||||||
| FaxNumber: | 2069875060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2009 | ||||||||
| LastUpdateDate: | 05/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0216X | 093200 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | 2080P0216X | MD60273913 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1025720450001 | 05 | PA | MEDICAID | 2954727 | 05 | OH | MEDICAID |