Healthcare Provider Details

I. General information

NPI: 1477280949
Provider Name (Legal Business Name): SUKHDEEP BHULLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10525 SE 213TH ST
KENT WA
98031-2046
US

IV. Provider business mailing address

10525 SE 213TH ST
KENT WA
98031-2046
US

V. Phone/Fax

Practice location:
  • Phone: 253-294-6111
  • Fax: 253-650-1482
Mailing address:
  • Phone: 253-259-9338
  • Fax: 253-650-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61320481
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: