Provider Demographics
NPI:1235960113
Name:CHI, STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12269 NE 12TH LN APT 209
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2344
Mailing Address - Country:US
Mailing Address - Phone:213-369-2986
Mailing Address - Fax:
Practice Address - Street 1:805 164TH ST SE STE 200
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6316
Practice Address - Country:US
Practice Address - Phone:425-745-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE613880731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice