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General NPI Number Information
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NPI Number | 1114763729
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Entity Type | Individual
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Provider Name | SAM ZHAN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/02/2024
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 690 BARNES BLVD
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98438-1303
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Country | US
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Telephone | 253-982-5505
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Fax |
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Provider Business Mailing Address
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Address Line | 1137 PALISADE BLVD
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City | DUPONT
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State | WA
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Zip | 98327-9749
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Country | US
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Telephone | 716-238-0719
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DENT.DE.70035415
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14025093-9926
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License Number State | UT
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