Healthcare Provider Details

I. General information

NPI: 1164959169
Provider Name (Legal Business Name): MICHAEL MANCHANG SIEW JR. DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 NE RAVENNA BLVD STE B
SEATTLE WA
98115-5566
US

IV. Provider business mailing address

916 NE RAVENNA BLVD STE B
SEATTLE WA
98115-5566
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-6181
  • Fax: 206-385-5820
Mailing address:
  • Phone: 206-525-6181
  • Fax: 206-385-5820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number37666
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number70011270
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number37666
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number70011270
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: