Provider Demographics
NPI:1164088183
Name:CHOUDHRY, OSMAN AHMED
Entity type:Individual
Prefix:
First Name:OSMAN
Middle Name:AHMED
Last Name:CHOUDHRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:OSMAN
Other - Middle Name:AHMED
Other - Last Name:CHOUDHRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1519 132ND ST SE STE G
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-616-3729
Mailing Address - Fax:
Practice Address - Street 1:1519 132ND ST SE STE G
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7203
Practice Address - Country:US
Practice Address - Phone:425-616-3729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30.0262571223G0001X
CA1078901223G0001X
390200000X
WADE615423081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program