Healthcare Provider Details

I. General information

NPI: 1821433400
Provider Name (Legal Business Name): NURANI, MITCHELL, KIM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24040 SE KENT KANGLEY RD UNIT E200
MAPLE VALLEY WA
98038-6934
US

IV. Provider business mailing address

24040 SE KENT KANGLEY RD UNIT E200
MAPLE VALLEY WA
98038-6934
US

V. Phone/Fax

Practice location:
  • Phone: 425-578-9152
  • Fax: 425-413-3816
Mailing address:
  • Phone: 425-578-9152
  • Fax: 425-413-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00008078
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHIFA A NURANI
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-578-6358