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General NPI Number Information
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NPI Number | 1497308159
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Entity Type | Individual
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Provider Name | KUMUDRA TIN SOE DMD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 7533 OLYMPIC VIEW DR STE C
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City | EDMONDS
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State | WA
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Zip | 98026-5524
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Country | US
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Telephone | 425-670-2392
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Fax | 425-776-8173
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Provider Business Mailing Address
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Address Line | 7623 222ND ST SW UNIT B
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City | EDMONDS
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State | WA
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Zip | 98026-7966
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Country | US
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Telephone | 626-551-8119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60972753
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License Number State | WA
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