Healthcare Provider Details

I. General information

NPI: 1275275695
Provider Name (Legal Business Name): MANJIT KAUR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 100TH ST SE STE B
EVERETT WA
98208-3832
US

IV. Provider business mailing address

2209 E 32ND ST
TACOMA WA
98404-4922
US

V. Phone/Fax

Practice location:
  • Phone: 425-312-0202
  • Fax:
Mailing address:
  • Phone: 253-593-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61538671
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: