Healthcare Provider Details

I. General information

NPI: 1174448104
Provider Name (Legal Business Name): GUNTAS KAUR SANGHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LILLY RD NE
OLYMPIA WA
98506-5101
US

IV. Provider business mailing address

5206 15TH AVE NE UNIT B301
LACEY WA
98516-3890
US

V. Phone/Fax

Practice location:
  • Phone: 604-617-5950
  • Fax:
Mailing address:
  • Phone: 604-617-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDRE.ML.70119396
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: