Healthcare Provider Details

I. General information

NPI: 1235958695
Provider Name (Legal Business Name): DW HAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 FACTORIA BLVD SE STE 1A
BELLEVUE WA
98006-5261
US

IV. Provider business mailing address

4140 FACTORIA BLVD SE STE 1A
BELLEVUE WA
98006-5261
US

V. Phone/Fax

Practice location:
  • Phone: 425-222-1234
  • Fax:
Mailing address:
  • Phone: 425-222-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA NUEVO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 907-301-6112