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1014 S 320th St Suite E Federal Way WA 98003-5344 | |
| (253) 529-0123 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1014 S 320th St, Federal Way, Washington |
| Authorized Official Name and Position | Jennie Phan (OFFICE MANAGER) |
| Authorized Official Contact | 2535290123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1014 S 320th St Suite E Federal Way WA 98003-5344 Ph: (253) 529-0123 | 1014 S 320th St Suite E Federal Way WA 98003-5344 Ph: (253) 529-0123 |
| NPI Number | 1811926173 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 01/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811926173 | NPI | - | NPPES |
| 5011739 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6403 (Washington) | Primary |
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