Healthcare Provider Details

I. General information

NPI: 1073194999
Provider Name (Legal Business Name): CHAE MOK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1
FPO AP
96350-1200
US

IV. Provider business mailing address

1959 NE PACIFIC ST # B-307
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 315-243-3260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61174667
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: