Provider Demographics
NPI:1912946633
Name:MEHTA, UDAY KANTILAL (MD)
Entity type:Individual
Prefix:
First Name:UDAY
Middle Name:KANTILAL
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:STE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4934
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4079
Practice Address - Street 1:16850 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4931
Practice Address - Country:US
Practice Address - Phone:253-395-1960
Practice Address - Fax:253-395-2013
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00029749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE72208Medicare UPIN