Provider Demographics
NPI:1134177413
Name:TRIVEDI, ASHISH M (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:M
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 D ST NE STE 103
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4163
Mailing Address - Country:US
Mailing Address - Phone:253-333-1637
Mailing Address - Fax:253-351-8509
Practice Address - Street 1:914 D ST NE STE 103
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4163
Practice Address - Country:US
Practice Address - Phone:253-333-1637
Practice Address - Fax:253-351-8509
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1113588Medicaid
H01438Medicare UPIN