Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE60470450 | WA |
Y | 1223P0221X | Pediatric Dentist | DE60470450 | WA |
N | 124Q00000X | Dental Hygienist | DH00007833 | WA |
NPI | 1003234899 |
---|---|
Provider Name | Amelia Chim |
First Address | Seattle, WA 98105-5649 |
Second Address | Seattle, WA 98105-5649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 03/06/2016 |