Healthcare Provider Details

I. General information

NPI: 1932821360
Provider Name (Legal Business Name): JASMEEN KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12934 SE KENT KANGLEY RD
KENT WA
98030-7940
US

IV. Provider business mailing address

25913 116TH AVE SE
KENT WA
98030-7818
US

V. Phone/Fax

Practice location:
  • Phone: 253-265-7629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: