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NPI Code Detail

MEDICARE: ELIZABETH BONG YOUNGJOHN LMT

MEDICARE: ELIZABETH BONG YOUNGJOHN LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistWA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790292530
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BONG YOUNGJOHN LMT
Provider Business Mailing Address
First Line : 1648 S 310TH ST STE 2
Second Line :
City : FEDERAL WAY
State : WA
Zip : 98003-4954
Country : US
Telephone Number : 253-304-6704
Fax Number :
Provider Business Practice Location Address
First Line : 5236 CALIFORNIA AVE SW STE D
Second Line :
City : SEATTLE
State : WA
Zip : 98136-1283
Country : US
Telephone Number : 206-331-3999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2018
Last Update Date : 01/02/2018

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