Basic Information
| Provider Information | |||||||||
| NPI: | 1912946633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | UDAY | ||||||||
| MiddleName: | KANTILAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 LIND AVE SW | ||||||||
| Address2: | STE 100 | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980574934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256565412 | ||||||||
| FaxNumber: | 4256564079 | ||||||||
| Practice Location | |||||||||
| Address1: | 16850 SE 272ND ST | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980424931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533951960 | ||||||||
| FaxNumber: | 2533952013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00029749 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.