MEDICARE: SEATTLE EAST ASIAN MEDICINE PLLC

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
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1891333662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEATTLE EAST ASIAN MEDICINE PLLC

Provider Business Mailing Address
First Line	:	5257 18TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-3409
Country	:	US
Telephone Number	:	646-309-6147
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 E MADISON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-5416
Country	:	US
Telephone Number	:	206-397-0025
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE CHIANG
Credential	:	LAC, EAMP
Telephone Number	:	646-309-6147

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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