Healthcare Provider Details

I. General information

NPI: 1124106679
Provider Name (Legal Business Name): INDERJEET KAUR RAMGOTRA EAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 E MADISON ST #200
SEATTLE WA
98112-4264
US

IV. Provider business mailing address

3130 E MADISON ST #200
SEATTLE WA
98112-4264
US

V. Phone/Fax

Practice location:
  • Phone: 206-328-3058
  • Fax: 425-869-7691
Mailing address:
  • Phone: 206-328-3058
  • Fax: 360-352-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMD000019469
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0001848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: