Healthcare Provider Details

I. General information

NPI: 1568020352
Provider Name (Legal Business Name): HEMAMALINI CHANDRASHEKHAR DDS, MDS, MDSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 618
SEATTLE WA
98101-1761
US

IV. Provider business mailing address

509 OLIVE WAY STE 618
SEATTLE WA
98101-1761
US

V. Phone/Fax

Practice location:
  • Phone: 206-880-0119
  • Fax: 888-830-6339
Mailing address:
  • Phone: 252-629-1154
  • Fax: 888-830-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDE61556525
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE61556525
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61556525
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: