Provider Demographics
NPI:1871212654
Name:DENG, SHIN (DE61266510)
Entity type:Individual
Prefix:
First Name:SHIN
Middle Name:
Last Name:DENG
Suffix:
Gender:M
Credentials:DE61266510
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 106TH AVE NE UNIT 515
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8696
Mailing Address - Country:US
Mailing Address - Phone:206-787-0066
Mailing Address - Fax:
Practice Address - Street 1:3820 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7825
Practice Address - Country:US
Practice Address - Phone:253-472-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE612665101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice