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General NPI Number Information
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NPI Number | 1881700920
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Entity Type | Organization
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Legal Business Name | KEVIN LEE DDS JOHANN TI DDS & MICHAEL HYODO DDS PLLC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9612 270TH ST NW 7C
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City | STANWOOD
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State | WA
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Zip | 98292
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Country | US
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Telephone | 360-629-1776
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Fax | 360-629-0541
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Provider Business Mailing Address
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Address Line | 9612 270TH ST NW 7C
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City | STANWOOD
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State | WA
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Zip | 98292
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Country | US
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Telephone | 360-629-1776
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Fax | 360-629-0541
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Authorized Official
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Title or Position | PARTNER
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Name | MR. JOHANN M TI
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Credential | DDS
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Telephone | 360-629-1776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6284
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7741
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9599
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8211
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License Number State | WA
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