MEDICARE: SORENSEN ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1194663708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SORENSEN ORTHODONTICS

Provider Business Mailing Address
First Line	:	4116 CALIFORNIA AVE SW APT 102
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4151
Country	:	US
Telephone Number	:	206-937-6089
Fax Number	:

Provider Business Practice Location Address
First Line	:	4116 CALIFORNIA AVE SW APT 102
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4151
Country	:	US
Telephone Number	:	206-937-6089
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. TAYLOR CHISHOLM
Credential	:
Telephone Number	:	206-937-6089

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “SORENSEN ORTHODONTICS ” Practice Location

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