Healthcare Provider Details

I. General information

NPI: 1770286676
Provider Name (Legal Business Name): MANJOT KAUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

IV. Provider business mailing address

24222 116TH PLACE SOUTHEAST
KENT WA
98030
US

V. Phone/Fax

Practice location:
  • Phone: 360-814-2115
  • Fax:
Mailing address:
  • Phone: 253-335-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.MD.70137337
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: