1336678697 NPI number — YONG HUANG MASSAGE PRACTITIONER

Table of content: YONG HUANG MASSAGE PRACTITIONER (NPI 1336678697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336678697 NPI number — YONG HUANG MASSAGE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUANG
Provider First Name:
YONG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASSAGE PRACTITIONER
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:
1336678697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12505 NE BEL RED RD STE 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-484-9023
Provider Business Mailing Address Fax Number:
206-309-9063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12505 BEL-RED ROAD
Provider Second Line Business Practice Location Address:
SUITE 188
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-484-9023
Provider Business Practice Location Address Fax Number:
206-309-9063
Provider Enumeration Date:
06/08/2017

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: 225700000X , with the licence number:  MA60655888 , 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: MA60655888 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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