Provider Demographics
NPI:1053347930
Name:OJHA, AMBRISH K (MD)
Entity type:Individual
Prefix:
First Name:AMBRISH
Middle Name:K
Last Name:OJHA
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 1:233 ST HELENS AVE
Mailing Address - Street 2:APT #405
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2581
Mailing Address - Country:US
Mailing Address - Phone:253-272-2436
Mailing Address - Fax:
Practice Address - Street 1:233 ST HELENS AVE
Practice Address - Street 2:APT #405
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2581
Practice Address - Country:US
Practice Address - Phone:253-272-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00044184OtherWA LICENSE
WA189176OtherDEPT L & I
WA8408890Medicaid
WABO9040104OtherDEA
WAMD00044184OtherWA LICENSE
WA8808027Medicare ID - Type Unspecified