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General NPI Number Information
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NPI Number | 1467771691
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Entity Type | Organization
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Legal Business Name | SHAO HSU GHORBANIAN PLLC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 20071 STATE ROUTE 410 E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8460
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Country | US
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Telephone | 253-862-1015
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Fax |
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Provider Business Mailing Address
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Address Line | 20071 STATE ROUTE 410 E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8460
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Country | US
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Telephone | 253-862-1015
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/DENTIST
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Name | DR. ANDY HSU
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Credential | DMD
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Telephone | 253-862-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10544
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License Number State | WA
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