Healthcare Provider Details

I. General information

NPI: 1801039151
Provider Name (Legal Business Name): JASJIT KHURANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 SYLVESTER RD SW
BURIEN WA
98166-3017
US

IV. Provider business mailing address

16251 SYLVESTER RD SW
BURIEN WA
98166-3017
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6341
  • Fax: 206-965-4119
Mailing address:
  • Phone: 253-426-6341
  • Fax: 206-965-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61021262
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: