MEDICARE: MICHIKO MAEDA HUANG 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	1223P0700X	Prosthodontics	0401413511	VA
2	1223P0700X	Prosthodontics	DE60276603	WA

General Provider Information

NPI Number	:	1609288554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHIKO MAEDA HUANG DDS

Provider Business Mailing Address
First Line	:	21727 76TH AVE W STE 110
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	205-948-5455
Fax Number	:

Provider Business Practice Location Address
First Line	:	21727 76TH AVE W STE 110
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	205-948-5455
Fax Number	:

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

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	07/21/2022

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