Individual
DR. SHAKTI K MATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MBBS, DCH, MD, FAAP
Contact information
Practice address
6802 W RIO GRANDE AVE STE 1, KENNEWICK, WA 99336-7684
(509) 572-2201
(509) 783-8844
Mailing address
6802 W RIO GRANDE AVE STE 1, KENNEWICK, WA 99336-7684
(509) 572-2201
(509) 783-8844
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00035969
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0124991
WA STATE DL&I #
WA
05
—
8227530
—
WA
Enumeration date
11/03/2006
Last updated
09/18/2012
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