Provider Demographics
NPI:1043318629
Name:RAJWANI, KHAIRUNNISSA S (MD)
Entity type:Individual
Prefix:DR
First Name:KHAIRUNNISSA
Middle Name:S
Last Name:RAJWANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 SE 2ND PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-8876
Mailing Address - Country:US
Mailing Address - Phone:253-951-7081
Mailing Address - Fax:
Practice Address - Street 1:2418 SE 2ND PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-8876
Practice Address - Country:US
Practice Address - Phone:253-951-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine