Provider Demographics
NPI:1619063476
Name:SUBARAN, HERMINIA HILO (LD)
Entity Type:Individual
Prefix:MS
First Name:HERMINIA
Middle Name:HILO
Last Name:SUBARAN
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N 145TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6202
Mailing Address - Country:US
Mailing Address - Phone:206-363-9223
Mailing Address - Fax:206-363-6550
Practice Address - Street 1:1205 N 145TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-6202
Practice Address - Country:US
Practice Address - Phone:206-363-9223
Practice Address - Fax:206-363-6550
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN-11122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5020599Medicaid