Bajwa Wong PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

BAJWA WONG PLLC

Doing business as

Eastside Modern Dentistry

Practice address

640 NW Gilman Blvd Ste 100
Issaquah, WA 98027-2476

Phone

(425) 507-2888

Fax

(425) 507-2887

NPI assigned

Apr 20, 2020

Last updated

Apr 20, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sofia Segura

Title

Credentialing Manager

Phone

(509) 901-2239

Specialties & licenses 1

Addresses

Other names 1

• Eastside Modern Dentistry Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Harmandeep Singh

  • Dentist
  • Issaquah, WA
  • NPI 1396633244
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1407476484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 NW GILMAN BLVD STE 100",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272476",
            "telephone_number": "425-507-2888",
            "fax_number": "425-507-2887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 NW GILMAN BLVD STE 100",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272476",
            "telephone_number": "425-507-2888",
            "fax_number": "425-507-2887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAJWA WONG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "SEGURA",
        "authorized_official_first_name": "SOFIA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "509-901-2239"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Briana Bachelder
• Anita Marie Bagley, LMT
• Lindsey Bailey
• Amy Jean Bain, CPNP
• Amelia Baisden, CNM, ARNP, DNP
• Aimee Bakeman
• Andrea Kay Baker, FNP-C
• Kailey Alexandra Baker, AT-C, OT-C
• Kimberly Sue Baker, PHARMD
• Balance Physical Therapy Inc, P.S.

• Dentist in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.