Provider Demographics
NPI:1013106665
Name:BENJAMIN, JYOTI (MD,RD, CD)
Entity type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD,RD, CD
Other - Prefix:
Other - First Name:JOTPRAKASH
Other - Middle Name:
Other - Last Name:TIWANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13451 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1475
Mailing Address - Country:US
Mailing Address - Phone:425-562-1337
Mailing Address - Fax:425-562-1331
Practice Address - Street 1:13451 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1475
Practice Address - Country:US
Practice Address - Phone:425-562-1337
Practice Address - Fax:425-562-1331
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001894133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039581OtherLABOR AND INDUSTRIES # VM
WA8502650Medicaid
WA6480BEOtherBLUE SHIELD # VM
WA8869648Medicare PIN