Organization
KALYAN DANDALA, MD PLLC
Active
Other names
DanMed
Organization subpart
No
Provider details
NPI number
Authorized official
MAGDALEN GUSTILO (DIRECTOR OF PAYER RELATIONS)
(714) 568-7667
Entity
Organization
Contact information
Practice address
350 S 38TH CT STE 100, RENTON, WA 98055-5777
(714) 828-1800
(714) 882-1186
Mailing address
18401 VON KARMAN AVE STE 500, IRVINE, CA 92612-8531
(714) 828-1800
(714) 882-1186
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
MD00048010
WA
363LA2200X
Adult Health Nurse Practitioner
AP30007637
WA
Other
Enumeration date
02/08/2013
Last updated
05/08/2023
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