MEDICARE: DR. JONATHAN AN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE60574158	WA

General Provider Information

NPI Number	:	1285017574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN AN D.D.S

Provider Business Mailing Address
First Line	:	5013 40TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-3041
Country	:	US
Telephone Number	:	253-353-5728
Fax Number	:

Provider Business Practice Location Address
First Line	:	8511 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-3613
Country	:	US
Telephone Number	:	206-782-8223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2015
Last Update Date	:	07/03/2015

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