Healthcare Provider Details

I. General information

NPI: 1194945675
Provider Name (Legal Business Name): AARON VAN WONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 MERIDIAN AVE N
SEATTLE WA
98133-9509
US

IV. Provider business mailing address

PO BOX 3835
SEATTLE WA
98124-3835
US

V. Phone/Fax

Practice location:
  • Phone: 206-296-4990
  • Fax: 206-205-5142
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-762-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00009435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: