1679918528 NPI number — NURANI, MITCHELL, KIM, PC

Table of content: (NPI 1679918528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679918528 NPI number — NURANI, MITCHELL, KIM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURANI, MITCHELL, KIM, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRIGHTNOW DENTAL - LAKE STEVENS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679918528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 STATE ROUTE 9 NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE STEVENS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-249-4129
Provider Business Mailing Address Fax Number:
425-334-8475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 STATE ROUTE 9 NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-249-4129
Provider Business Practice Location Address Fax Number:
425-334-8475
Provider Enumeration Date:
05/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
NURANI
Authorized Official First Name:
ASHIFA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-578-6358

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE00008078 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223D0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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