=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578221255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUSHNER AUBURN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2021
-----------------------------------------------------
Last Update Date | 11/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32114 1ST AVE S STE 104
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-5760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-236-5240
-----------------------------------------------------
Fax | 866-861-6286
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32114 1ST AVE S STE 104
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-5760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-236-5240
-----------------------------------------------------
Fax | 866-861-6286
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TANYA A GUREVICH KUSHNER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 360-779-7711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X2210X
-----------------------------------------------------
Taxonomy Name | Orofacial Pain Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------