Provider Demographics
NPI:1548626351
Name:HKC DDS INC
Entity type:Organization
Organization Name:HKC DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-686-7797
Mailing Address - Street 1:20615 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8556
Mailing Address - Country:US
Mailing Address - Phone:425-686-7797
Mailing Address - Fax:
Practice Address - Street 1:20615 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8556
Practice Address - Country:US
Practice Address - Phone:425-686-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60305935122300000X
WADE60505765122300000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1831106293Medicaid
WA1174923817Medicaid