Healthcare Provider Details

I. General information

NPI: 1891612495
Provider Name (Legal Business Name): KARANJOT KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10725 SE 256TH ST STE 1
KENT WA
98030-8285
US

IV. Provider business mailing address

25614 169TH PL SE
COVINGTON WA
98042-8303
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-2714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70121934
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: