Provider Demographics
NPI:1104171974
Name:SIDHU, KANWARDEEP KAUR (MD)
Entity type:Individual
Prefix:DR
First Name:KANWARDEEP
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:205 10TH ST NE
Mailing Address - Street 2:STE 200
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4019
Mailing Address - Country:US
Mailing Address - Phone:253-351-5300
Mailing Address - Fax:253-351-5399
Practice Address - Street 1:205 10TH ST NE
Practice Address - Street 2:STE 200
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4019
Practice Address - Country:US
Practice Address - Phone:253-351-5300
Practice Address - Fax:253-351-5399
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60511455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine