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NPI Code Detail

MEDICARE: IM GHORBANIAN KAHLON DDS PLLC

MEDICARE: IM GHORBANIAN KAHLON DDS PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11518111541OTHERWANPI INDIVIDUAL
21013323518OTHERWANPI INDIVIDUAL
31275606188OTHERWANPI INDIVIDUAL
41023149358OTHERWANPI INDIVIDUAL

General Provider Information

NPI Number : 1477057255
Entity Type Code : Organization
Provider Name (Legal Business Name) : IM GHORBANIAN KAHLON DDS PLLC
Provider Business Mailing Address
First Line : 404 MAIN AVE S
Second Line :
City : NORTH BEND
State : WA
Zip : 98045-8215
Country : US
Telephone Number : 425-669-9015
Fax Number :
Provider Business Practice Location Address
First Line : 404 MAIN AVE S
Second Line :
City : NORTH BEND
State : WA
Zip : 98045-8215
Country : US
Telephone Number : 425-669-9015
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : SARAH IM
Credential :
Telephone Number : 425-669-9015
Provider Enumeration Date : 03/19/2018
Last Update Date : 03/19/2018

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