Healthcare Provider Details

I. General information

NPI: 1306227277
Provider Name (Legal Business Name): SARAH KHAN DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 1024
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

509 OLIVE WAY STE 1024
SEATTLE WA
98101-1720
US

V. Phone/Fax

Practice location:
  • Phone: 206-289-0790
  • Fax:
Mailing address:
  • Phone: 206-289-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARAH KHAN
Title or Position: OWNER
Credential: DMD
Phone: 206-289-0790