Basic Information
Provider Information
NPI: 1790121648
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TANDON
FirstName: KARMAN
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1115 SE 164TH AVE DEPT 358
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986838004
CountryCode: US
TelephoneNumber: 3607291462
FaxNumber: 3607293104
Practice Location
Address1: 4545 CORDATA PKWY STE 1E
Address2:  
City: BELLINGHAM
State: WA
PostalCode: 98226
CountryCode: US
TelephoneNumber: 3607382200
FaxNumber: 3607525679
Other Information
ProviderEnumerationDate: 05/20/2013
LastUpdateDate: 07/30/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD60657233WAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0000XMD60657233WAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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