Healthcare Provider Details

I. General information

NPI: 1164771812
Provider Name (Legal Business Name): GURMINDER S HOTHI CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. GARY HOTHI

II. Dates (important events)

Enumeration Date: 09/09/2012
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 AUBURN WAY N
AUBURN WA
98002-1311
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-2000
  • Fax:
Mailing address:
  • Phone: 206-302-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00006423
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: