=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225167943
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. JAGJIT BHUI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 07/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9300 NE VANCOUVER MALL DR SUITE 100
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-8201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-695-5555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9300 NE VANCOUVER MALL DR SUITE# 100
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-8201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-695-5555
-----------------------------------------------------
Fax | 360-253-6437
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8609
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------