Healthcare Provider Details

I. General information

NPI: 1023933413
Provider Name (Legal Business Name): DR. ALFRED JOSEPH RAVIKUMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 BURDEN BLVD
PASCO WA
99301-9822
US

IV. Provider business mailing address

429 HESPER AVE APT C
METAIRIE LA
70005-3262
US

V. Phone/Fax

Practice location:
  • Phone: 509-728-9460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.70150932
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: