Healthcare Provider Details

I. General information

NPI: 1457071433
Provider Name (Legal Business Name): BIRGA RAJ GURUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 05/08/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SEWARD PARK AVE S
SEATTLE WA
98118-4247
US

IV. Provider business mailing address

5300 TALLMAN AVE NW
SEATTLE WA
98107-3932
US

V. Phone/Fax

Practice location:
  • Phone: 206-725-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61432543
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60261062
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: