Individual
DR. KALYAN S. WADWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E. KINCAID STREET, MOUNT VERNON, WA 98274-4127
(360) 428-2555
(360) 428-6402
Mailing address
1400 E. KINCAID STREET, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
21405
NE
207RG0100X
Gastroenterology Physician
39078
WA
207RG0100X
Gastroenterology Physician
48268
MD
207RG0100X
Gastroenterology Physician
9801542
NC
207RG0100X
Gastroenterology Physician
Primary
MD00039078
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263671
LABOR & INDUSTRIES
WA
Enumeration date
10/18/2006
Last updated
11/03/2010
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