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General NPI Number Information
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NPI Number | 1649591652
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Entity Type | Individual
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Provider Name | TIK-SHUN LI DMD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 1959 NE PACIFIC ST HSB ROOM D 258
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City | SEATTLE
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State | WA
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Zip | 98195-0001
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Country | US
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Telephone | 617-595-0171
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Fax |
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Provider Business Mailing Address
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Address Line | 3222 W. 26TH AVE
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City | VANCOUVER
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State | BRITISH COLUMBIA
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Zip | V6C1W1
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Country | CA
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DR60093493
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License Number State | WA
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