1174066484 NPI number — COMFY DENTURE & HEARING SERVICE CORP

Table of content: (NPI 1174066484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174066484 NPI number — COMFY DENTURE & HEARING SERVICE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFY DENTURE & HEARING SERVICE CORP
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:
6
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:
1174066484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16014 24TH ST E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE TAPPS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98391-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-886-0855
Provider Business Mailing Address Fax Number:
253-941-3896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18802 MOUNTAIN VIEW DR E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-7110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-886-0855
Provider Business Practice Location Address Fax Number:
253-941-3896
Provider Enumeration Date:
11/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
MINSEOK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-886-0855

Provider Taxonomy Codes

  • Taxonomy code: 122400000X , with the licence number:  DN60300984 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X , with the licence number: HA60239129 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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