Provider Demographics
NPI:1174609622
Name:NURANI, MITCHELL, KIM, PC
Entity type:Organization
Organization Name:NURANI, MITCHELL, KIM, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARACELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTENEGRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:100 IRVINE CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:714-578-6358
Mailing Address - Fax:714-428-1390
Practice Address - Street 1:2101 NE 129TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3264
Practice Address - Country:US
Practice Address - Phone:360-574-4574
Practice Address - Fax:360-574-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000080781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty