Provider Demographics
NPI:1730247073
Name:BADYAL, MOHINDER SINGH (MD)
Entity type:Individual
Prefix:
First Name:MOHINDER
Middle Name:SINGH
Last Name:BADYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32124 1ST AVE S
Mailing Address - Street 2:STE100
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5761
Mailing Address - Country:US
Mailing Address - Phone:253-661-5939
Mailing Address - Fax:253-661-5929
Practice Address - Street 1:32124 1ST AVE S
Practice Address - Street 2:STE100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5761
Practice Address - Country:US
Practice Address - Phone:253-661-5939
Practice Address - Fax:253-661-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000313372080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE-98076Medicare UPIN