Healthcare Provider Details

I. General information

NPI: 1508311366
Provider Name (Legal Business Name): RAMANPREET DHALIWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 SE 256TH ST STE 101
KENT WA
98030-6809
US

IV. Provider business mailing address

11128 SE 233RD PL
KENT WA
98031-3494
US

V. Phone/Fax

Practice location:
  • Phone: 206-422-5953
  • Fax:
Mailing address:
  • Phone: 206-422-5953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number143594
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: