1831435197 NPI number — ORAL AND FACIAL SURGERY CENTER OF SEATTLE

Table of content: DR. JOHNATHAN HAO SUN D.O. (NPI 1932342771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831435197 NPI number — ORAL AND FACIAL SURGERY CENTER OF SEATTLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL AND FACIAL SURGERY CENTER OF SEATTLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831435197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 OLIVE WAY
Provider Second Line Business Mailing Address:
SUITE 1331
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-1720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-624-0852
Provider Business Mailing Address Fax Number:
206-622-2084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 OLIVE WAY
Provider Second Line Business Practice Location Address:
SUITE 1331
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-0852
Provider Business Practice Location Address Fax Number:
206-622-2084
Provider Enumeration Date:
12/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HARALSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-624-0852

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  60295571 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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