Healthcare Provider Details

I. General information

NPI: 1780142729
Provider Name (Legal Business Name): SHOKO SATO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S 320TH ST STE 330
FEDERAL WAY WA
98003-5461
US

IV. Provider business mailing address

2505 S 320TH ST STE 330
FEDERAL WAY WA
98003-5461
US

V. Phone/Fax

Practice location:
  • Phone: 206-400-0800
  • Fax: 253-874-9068
Mailing address:
  • Phone: 206-400-0800
  • Fax: 253-874-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE60628832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: