Provider Demographics
NPI:1376858316
Name:KATCHOOI, MINA (DDS)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:KATCHOOI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 EASTLAKE AVE E
Mailing Address - Street 2:APT 409
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3131
Mailing Address - Country:US
Mailing Address - Phone:478-390-1960
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60280052122300000X
IN12011423A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist