Healthcare Provider Details

I. General information

NPI: 1881514792
Provider Name (Legal Business Name): INTERNATIONAL COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3826 S OTHELLO ST
SEATTLE WA
98118-3562
US

IV. Provider business mailing address

720 8TH AVE S
SEATTLE WA
98104-3006
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3613
  • Fax:
Mailing address:
  • Phone: 206-788-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: HERMES SHAHBAZIAN
Title or Position: CFO
Credential:
Phone: 206-788-3618