Provider Demographics
NPI:1982765590
Name:LEE-CHIU, SAMANTHA ELAINE (DDS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:LEE-CHIU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ELAINE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:1629 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6701
Practice Address - Country:US
Practice Address - Phone:206-548-3114
Practice Address - Fax:206-762-6355
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice