Provider Demographics
NPI:1336291988
Name:MIAO, JIN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:S
Last Name:MIAO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AA DENTAL CENTER
Mailing Address - Street 2:SUITE #100 1401 E 4TH AVE
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-753-7388
Mailing Address - Fax:360-753-3553
Practice Address - Street 1:AA DENTAL CENTER
Practice Address - Street 2:SUITE #100 1401 E 4TH AVE
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-753-7388
Practice Address - Fax:360-753-3553
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 78301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5040332Medicaid