Healthcare Provider Details

I. General information

NPI: 1003234899
Provider Name (Legal Business Name): AMELIA CHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MARY GATES MEMORIAL DR NE APT U253
SEATTLE WA
98105-5649
US

IV. Provider business mailing address

4200 MARY GATES MEMORIAL DR NE APT U253
SEATTLE WA
98105-5649
US

V. Phone/Fax

Practice location:
  • Phone: 206-383-9338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60470450
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE60470450
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00007833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: