1629683909 NPI number — BOHOU LI

Table of content: BOHOU LI (NPI 1629683909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629683909 NPI number — BOHOU LI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
BOHOU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1629683909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2916 S 200TH ST SPC 63
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATAC
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98198-5767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14133 NE 7TH PL APT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-4756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-393-8670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2020

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: 171R00000X , with the licence number:  MC56737 , 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: MC56737 . This is a "DEPARTMENT OF SOCIAL AND HEALTH SERVICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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