Healthcare Provider Details

I. General information

NPI: 1447215215
Provider Name (Legal Business Name): KIPP R BAJAJ ND, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 NE 20TH AVE STE 1102
VANCOUVER WA
98686-6410
US

IV. Provider business mailing address

904 W 21ST ST # 2
VANCOUVER WA
98660-2471
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-7373
  • Fax:
Mailing address:
  • Phone: 360-699-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1052
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001285
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: