Provider Demographics
NPI:1861365587
Name:VIROJSAKULCHAI, KANVARA (DDS)
Entity type:Individual
Prefix:
First Name:KANVARA
Middle Name:
Last Name:VIROJSAKULCHAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 184TH ST SW UNIT D410
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4997
Mailing Address - Country:US
Mailing Address - Phone:323-698-6939
Mailing Address - Fax:
Practice Address - Street 1:1418 164TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8500
Practice Address - Country:US
Practice Address - Phone:425-742-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE700229541223X2210X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X2210XDental ProvidersDentistOrofacial Pain