Provider Demographics
NPI:1336757988
Name:TRANGCHIU, SHEILA KIM
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:KIM
Last Name:TRANGCHIU
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 1:2360 THAIN GRADE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4115
Mailing Address - Country:US
Mailing Address - Phone:208-717-1966
Mailing Address - Fax:
Practice Address - Street 1:2360 THAIN GRADE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4115
Practice Address - Country:US
Practice Address - Phone:208-717-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist