Basic Information
| Provider Information | |||||||||
| NPI: | 1255759007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIAN | ||||||||
| FirstName: | WEI | ||||||||
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| Credential: | BMED, MSD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8915 14TH AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981084813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067623263 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8915 14TH AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981084813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067623263 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2014 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DE60328531 | WA | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.