Basic Information
Provider Information
NPI: 1558893974
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAINI
FirstName: JASJIT
MiddleName: KAUR
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 NE 87TH AVE
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986644896
CountryCode: US
TelephoneNumber: 3608822778
FaxNumber:  
Practice Location
Address1: 2525 NE 139TH ST STE 130
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986862719
CountryCode: US
TelephoneNumber: 3608822778
FaxNumber: 3606041675
Other Information
ProviderEnumerationDate: 04/03/2017
LastUpdateDate: 08/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOP61083390WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home