Healthcare Provider Details

I. General information

NPI: 1578221255
Provider Name (Legal Business Name): KUSHNER AUBURN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32114 1ST AVE S STE 104
FEDERAL WAY WA
98003-5760
US

IV. Provider business mailing address

32114 1ST AVE S STE 104
FEDERAL WAY WA
98003-5760
US

V. Phone/Fax

Practice location:
  • Phone: 253-236-5240
  • Fax: 866-861-6286
Mailing address:
  • Phone: 253-236-5240
  • Fax: 866-861-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: TANYA A GUREVICH KUSHNER
Title or Position: OWNER
Credential: DDS
Phone: 360-779-7711