Healthcare Provider Details

I. General information

NPI: 1336720762
Provider Name (Legal Business Name): MOHAMED ELAMEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 S 188TH ST STE 201
SEATAC WA
98188-5070
US

IV. Provider business mailing address

4400 37TH AVE S
SEATTLE WA
98118-1609
US

V. Phone/Fax

Practice location:
  • Phone: 206-439-2149
  • Fax:
Mailing address:
  • Phone: 206-296-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61165875
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: