Provider Demographics
NPI:1891197372
Name:MANGAT-SOHI, KIRAN
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:MANGAT-SOHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19102 20TH DR SE
Mailing Address - Street 2:UNIT F102
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 120TH AVE NE
Practice Address - Street 2:SUITE D103
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3026
Practice Address - Country:US
Practice Address - Phone:425-467-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60475677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist