Healthcare Provider Details

I. General information

NPI: 1912446774
Provider Name (Legal Business Name): ANDRE-DAVID KAHWACH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF WASHINGTON DEPARTMENT OF ORAL 1959 NE PACIFIC STREET
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

DEPT. OF ORAL & MAXILLOFACIAL SURGEY 1959 NE PACIFIC STREET, BOX 357134
SEATTLE WA
98195
US

V. Phone/Fax

Practice location:
  • Phone: 415-997-0004
  • Fax:
Mailing address:
  • Phone: 424-232-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR60753080
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: