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General NPI Number Information
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NPI Number | 1790669406
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Entity Type | Individual
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Provider Name | SHANE YIN KOO DMD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 9900 LINCOLN ST 2ND FLOOR
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 930 ROSS LOOP APT D403
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City | DUPONT
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State | WA
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Zip | 98327-9052
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Country | US
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Telephone | 786-202-5218
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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 | DN30451
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License Number State | FL
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