Provider Demographics
NPI:1740060821
Name:KAMRAN SHEMSHAKI, DMD, PS
Entity type:Organization
Organization Name:KAMRAN SHEMSHAKI, DMD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMSHAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-614-1515
Mailing Address - Street 1:14150 NE 20TH ST STE F2
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3700
Mailing Address - Country:US
Mailing Address - Phone:425-614-1515
Mailing Address - Fax:425-614-1616
Practice Address - Street 1:14150 NE 20TH ST STE F2
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3700
Practice Address - Country:US
Practice Address - Phone:425-614-1515
Practice Address - Fax:425-614-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental