Healthcare Provider Details

I. General information

NPI: 1083945117
Provider Name (Legal Business Name): JIAN FENG HUANG LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 BEL RED RD STE 188
BELLEVUE WA
98005-2510
US

IV. Provider business mailing address

12505 BEL RED RD STE 188
BELLEVUE WA
98005-2510
US

V. Phone/Fax

Practice location:
  • Phone: 425-484-9023
  • Fax:
Mailing address:
  • Phone: 425-484-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60109480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: