Healthcare Provider Details

I. General information

NPI: 1780518837
Provider Name (Legal Business Name): CHAN BRACES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19020 BOTHELL WAY NE STE A
BOTHELL WA
98011-2996
US

IV. Provider business mailing address

19020 BOTHELL WAY NE STE A
BOTHELL WA
98011-2996
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-9332
  • Fax:
Mailing address:
  • Phone: 907-738-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN KENWORTHY
Title or Position: PROVIDER
Credential:
Phone: 469-963-0340