Provider Demographics
NPI:1477057255
Name:IM GHORBANIAN KAHLON DDS PLLC
Entity Type:Organization
Organization Name:IM GHORBANIAN KAHLON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-669-9015
Mailing Address - Street 1:404 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8215
Mailing Address - Country:US
Mailing Address - Phone:425-669-9015
Mailing Address - Fax:
Practice Address - Street 1:404 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8215
Practice Address - Country:US
Practice Address - Phone:425-669-9015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1518111541OtherNPI INDIVIDUAL
WA1013323518OtherNPI INDIVIDUAL
WA1275606188OtherNPI INDIVIDUAL
WA1023149358OtherNPI INDIVIDUAL