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General NPI Number Information
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NPI Number | 1003234899
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Entity Type | Individual
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Provider Name | AMELIA CHIM
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Gender | Female
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 4200 MARY GATES MEMORIAL DR NE APT U253
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City | SEATTLE
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State | WA
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Zip | 98105-5649
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Country | US
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Telephone | 206-383-9338
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 MARY GATES MEMORIAL DR NE APT U253
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City | SEATTLE
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State | WA
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Zip | 98105-5649
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60470450
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH00007833
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60470450
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License Number State | WA
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