1528196052 NPI number — CHRISTIAN FAMILY CARE INC

Table of content: (NPI 1528196052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528196052 NPI number — CHRISTIAN FAMILY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN FAMILY CARE INC
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:
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:
1528196052
Entity Type Code:
Organization
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:
8511 SOUTH TACOMA WAY #200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-588-4015
Provider Business Mailing Address Fax Number:
253-588-4035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33507 9TH AVE S
Provider Second Line Business Practice Location Address:
BUILDING A
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-5404
Provider Business Practice Location Address Fax Number:
253-874-8964
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
YOUNG
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-874-5404

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD00044106 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD00029607 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: AP30006909 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP30006915 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP30006808 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP60126966 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: MD00029607 , 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: 1014389 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386694982 . This is a "JAI JUN BYEON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1609836717 . This is a "YOUNG JU NAM, ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2003030 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1114743 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922101500 . This is a "YOUNG H. LEE, MD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8453284 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94964303 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033556 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679610885 . This is a "KI-DEUK WOHLFERT, ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699004234 . This is a "DOSOON SOH, ARNP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1022327 . This is a "PROVIDERONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0155621 . This is a "L&I, YOUNG H. LEE, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2007050 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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