1518043181 NPI number — YOUNGWUK AN DC

Table of content: YOUNGWUK AN DC (NPI 1518043181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518043181 NPI number — YOUNGWUK AN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AN
Provider First Name:
YOUNGWUK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1518043181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6951 MARTIN LUTHER KING JR WAY S
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98118-3597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-721-7200
Provider Business Mailing Address Fax Number:
206-339-7200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6951 MARTIN LUTHER KING JR WAY S
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-3597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-7200
Provider Business Practice Location Address Fax Number:
206-339-7200
Provider Enumeration Date:
10/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  CH 60064547 , 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)

  • Identifier: 4707680 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".