Healthcare Provider Details

I. General information

NPI: 1699296491
Provider Name (Legal Business Name): AVEENA GURUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 W OKANOGAN PL
KENNEWICK WA
99336-8001
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2528
  • Fax: 509-783-2008
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD61225244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: