MEDICARE: DR. IMAHN MOIN DDS

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	1223G0001X	General Practice Dentistry	DE60473156	WA

General Provider Information

NPI Number	:	1215342233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMAHN MOIN DDS

Provider Business Mailing Address
First Line	:	3941 WALLINGFORD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8247
Country	:	US
Telephone Number	:	603-391-6259
Fax Number	:

Provider Business Practice Location Address
First Line	:	4547 8TH AVE NE
Second Line	:	APT 311
City	:	SEATTLE
State	:	WA
Zip	:	98105-6702
Country	:	US
Telephone Number	:	603-391-6259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	07/22/2022

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