Provider Demographics
NPI:1063945368
Name:GOPALAKRISHNAN RAVIKUMAR, NAVEEN PRASAD (MD)
Entity type:Individual
Prefix:MR
First Name:NAVEEN PRASAD
Middle Name:
Last Name:GOPALAKRISHNAN RAVIKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HOLTON AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3245
Mailing Address - Country:US
Mailing Address - Phone:509-248-6292
Mailing Address - Fax:509-248-9134
Practice Address - Street 1:315 HOLTON AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3245
Practice Address - Country:US
Practice Address - Phone:509-248-6292
Practice Address - Fax:509-248-9134
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61207757207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program