Provider Demographics
NPI:1912014440
Name:KATHURIA, SABEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:SABEENA
Middle Name:
Last Name:KATHURIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S J ST FL 2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7503
Mailing Address - Fax:253-274-7993
Practice Address - Street 1:1608 S J ST FL 2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7503
Practice Address - Fax:253-274-7993
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40461208000000X
WAMD60635735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32477300Medicaid
BK6073439OtherDEA NUMBER
BK6073439OtherDEA NUMBER
17100Medicare ID - Type UnspecifiedMEDICARE PROVIDER