MEDICARE: DR. KYLE SORENSEN D.M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	342	OK

General Provider Information

NPI Number	:	1992933238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE SORENSEN D.M.D.

Provider Business Mailing Address
First Line	:	509 OLIVE WAY STE 1207
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1745
Country	:	US
Telephone Number	:	206-621-9047
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY STE 1207
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1745
Country	:	US
Telephone Number	:	206-621-9047
Fax Number	:	206-624-4664

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	09/29/2025

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