Provider Demographics
NPI:1194983593
Name:KHANGURA, JASPREET KAUR (MD)
Entity type:Individual
Prefix:
First Name:JASPREET
Middle Name:KAUR
Last Name:KHANGURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JASPREET
Other - Middle Name:KAUR
Other - Last Name:DHOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:417 SE 164TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8944
Mailing Address - Country:US
Mailing Address - Phone:360-898-8944
Mailing Address - Fax:
Practice Address - Street 1:4500 SE COLUMBIA PALISADES DR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8444
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD150146207R00000X
WAMD60331001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025001Medicaid