=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891256350
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GURPREET KAUR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2019
-----------------------------------------------------
Last Update Date | 03/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 626 2ND AVE S
-----------------------------------------------------
City | OKANOGAN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-422-6705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 252 LYONS PL NE
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98059-5193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-894-6768
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE61068950
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------