| NPI | 1275951295 |
|---|---|
| Other Name | ICHS SHORELINE MEDICAL AND DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | HERMES SHAHBAZIAN CFO 200-788-3618 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WA 600436519) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 600436519) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2021-03-29 |