Provider Demographics
NPI:1801485818
Name:KULSHAN ORAL SURGERY
Entity type:Organization
Organization Name:KULSHAN ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-441-3999
Mailing Address - Street 1:2141 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9183
Mailing Address - Country:US
Mailing Address - Phone:360-441-3999
Mailing Address - Fax:
Practice Address - Street 1:2210 KULSHAN VIEW DR STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2779
Practice Address - Country:US
Practice Address - Phone:360-424-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty