Healthcare Provider Details

I. General information

NPI: 1609288554
Provider Name (Legal Business Name): MICHIKO MAEDA HUANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21727 76TH AVE W STE 110
EDMONDS WA
98026-7549
US

IV. Provider business mailing address

21727 76TH AVE W STE 110
EDMONDS WA
98026-7549
US

V. Phone/Fax

Practice location:
  • Phone: 205-948-5455
  • Fax:
Mailing address:
  • Phone: 205-948-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401413511
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE60276603
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: