Healthcare Provider Details

I. General information

NPI: 1699064360
Provider Name (Legal Business Name): HSU KIM AND GHORBANIAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 W WASHINGTON ST #303
SEQUIM WA
98382-3227
US

IV. Provider business mailing address

1258 W WASHINGTON ST #303
SEQUIM WA
98382-3227
US

V. Phone/Fax

Practice location:
  • Phone: 360-797-1100
  • Fax:
Mailing address:
  • Phone: 360-797-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10147
License Number StateWA

VIII. Authorized Official

Name: KAREN CROUSE
Title or Position: ACCOUNTANT
Credential: CPA
Phone: 360-457-3303