Individual
VIJENDRA KOTTURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(425) 228-3220
(253) 395-1954
Mailing address
PO BOX 59028, RENTON, WA 98058-2028
(425) 251-5110
(425) 793-7458
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA09045100
NJ
207R00000X
Internal Medicine Physician
MD60051023
WA
208M00000X
Hospitalist Physician
25MA09045100
NJ
208M00000X
Hospitalist Physician
MD60051023
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0272031
L&I
WA
05
—
2002120
—
WA
01
—
P00927875
MEDICARE RAILROAD
WA
Enumeration date
07/02/2007
Last updated
12/28/2023
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