Healthcare Provider Details

I. General information

NPI: 1548626351
Provider Name (Legal Business Name): HKC DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20615 BOTHELL EVERETT HWY SUITE A
BOTHELL WA
98012-8556
US

IV. Provider business mailing address

20615 BOTHELL EVERETT HWY SUITE A
BOTHELL WA
98012-8556
US

V. Phone/Fax

Practice location:
  • Phone: 425-686-7797
  • Fax:
Mailing address:
  • Phone: 425-686-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60305935
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60505765
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HENRY CHIANG
Title or Position: DENTIST
Credential: DDS
Phone: 425-686-7797