Provider Demographics
NPI:1467594465
Name:STATE OF WA, DEPT. OF SOCIAL AND HEALTH SVS.
Entity Type:Organization
Organization Name:STATE OF WA, DEPT. OF SOCIAL AND HEALTH SVS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-361-3033
Mailing Address - Street 1:3540 LAKE WASHINGTON BLVD SE
Mailing Address - Street 2:#211
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1105
Mailing Address - Country:US
Mailing Address - Phone:425-221-0228
Mailing Address - Fax:
Practice Address - Street 1:15230 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7130
Practice Address - Country:US
Practice Address - Phone:206-361-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty