MEDICARE: DR. SOUMYA PANDEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE60574393	WA

General Provider Information

NPI Number	:	1285915074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOUMYA PANDEY

Provider Business Mailing Address
First Line	:	5611 119TH AVE SE STE 2
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-3799
Country	:	US
Telephone Number	:	425-746-6554
Fax Number	:

Provider Business Practice Location Address
First Line	:	5611 119TH AVE SE STE 2
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-3799
Country	:	US
Telephone Number	:	425-746-6554
Fax Number	:	425-746-0145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	03/02/2026

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1316031446 — DR. ROBERT B TOMBERG D.D.S.
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1801970371 — MATT A PILOT DDS
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1487788527 — CARMI ROMONA JORGENSEN L.M.T. M.M.P.
Practice Location Address:

5611 119TH AVE SE , SUITE #4
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Practice Location Address:

5611 119TH AVE SE , SUITE 5
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1528467289 — DOROTHY LAURA JOHNSON
Practice Location Address:

5611 119TH AVE SE , SUITE 4
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Practice Fax:

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