Healthcare Provider Details

I. General information

NPI: 1033539903
Provider Name (Legal Business Name): AMIT SINGH KAINTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date: 11/21/2014
Reactivation Date: 01/08/2015

III. Provider practice location address

1802 YAKIMA AVE STE 204
TACOMA WA
98405-5304
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 204
TACOMA WA
98405-5304
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8540
  • Fax: 253-382-8545
Mailing address:
  • Phone: 253-382-8540
  • Fax: 253-382-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD201688
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD61425304
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD201688
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: