Healthcare Provider Details

I. General information

NPI: 1558119172
Provider Name (Legal Business Name): KULMINDER BAHI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 NORTHUP WAY
BELLEVUE WA
98004-1449
US

IV. Provider business mailing address

16211 31 AVENUE
SURREY BRITISH COLUMBIA
V3Z7E1
CA

V. Phone/Fax

Practice location:
  • Phone: 425-873-8587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE61452847
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: