Healthcare Provider Details

I. General information

NPI: 1730276940
Provider Name (Legal Business Name): WUITENG KOH, DDS, MS, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 5TH AVE NE SUITE 100
SEATTLE WA
98125-6151
US

IV. Provider business mailing address

11050 5TH AVE NE SUITE 100
SEATTLE WA
98125-6151
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-3666
  • Fax: 206-440-3298
Mailing address:
  • Phone: 206-365-3666
  • Fax: 206-440-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6944
License Number StateWA

VIII. Authorized Official

Name: WUITENG KOH
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 206-365-3666