Healthcare Provider Details

I. General information

NPI: 1740808005
Provider Name (Legal Business Name): SEHEE IRENA RIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

IV. Provider business mailing address

3317 GONZAGA CT SE
LACEY WA
98503-6233
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9595
  • Fax: 360-330-9580
Mailing address:
  • Phone: 630-709-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.032793
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61081766
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: