Basic Information
| Provider Information | |||||||||
| NPI: | 1578193223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUR | ||||||||
| FirstName: | SABLEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11244 SE 267TH PL | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980307179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064833257 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22415 SE 231ST ST | ||||||||
| Address2: | |||||||||
| City: | MAPLE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980385000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259064300 | ||||||||
| FaxNumber: | 4259064321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2020 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.