Provider Demographics
NPI:1699732693
Name:KOCHHAR, MOLINA KAUR (DPM)
Entity type:Individual
Prefix:
First Name:MOLINA
Middle Name:KAUR
Last Name:KOCHHAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LILLY RD NE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5255
Mailing Address - Country:US
Mailing Address - Phone:360-742-3492
Mailing Address - Fax:360-878-9674
Practice Address - Street 1:520 LILLY RD NE BLDG 1
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5255
Practice Address - Country:US
Practice Address - Phone:360-742-3492
Practice Address - Fax:360-878-9674
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO675213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2323KOOtherREGENCE RIDER
WA1114172Medicaid
WA0153447OtherL&I
4456780001Medicare NSC
WAGAB25651Medicare PIN
WA0153447OtherL&I