MEDICARE: DR. HEMAMALINI CHANDRASHEKHAR DDS, MDS, MDSC

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	1223X2210X	Orofacial Pain Dentistry	DE61556525	WA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DE61556525	WA
3	122300000X	Dentist	DE61556525	WA

General Provider Information

NPI Number	:	1568020352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEMAMALINI CHANDRASHEKHAR DDS, MDS, MDSC

Provider Business Mailing Address
First Line	:	509 OLIVE WAY STE 618
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1761
Country	:	US
Telephone Number	:	252-629-1154
Fax Number	:	888-830-6339

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY STE 618
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1761
Country	:	US
Telephone Number	:	206-880-0119
Fax Number	:	888-830-6339

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	09/27/2025

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