Provider Demographics
NPI:1093435034
Name:HSIEH, SHIN JUNG
Entity Type:Individual
Prefix:
First Name:SHIN JUNG
Middle Name:
Last Name:HSIEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 15TH AVE NE APT 314
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4404
Mailing Address - Country:US
Mailing Address - Phone:347-749-6849
Mailing Address - Fax:
Practice Address - Street 1:1270 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5410
Practice Address - Country:US
Practice Address - Phone:206-260-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61330044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist