Healthcare Provider Details

I. General information

NPI: 1427960558
Provider Name (Legal Business Name): NICKITA H CHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13353 NE BEL RED RD STE 103
BELLEVUE WA
98005-2329
US

IV. Provider business mailing address

13353 NE BEL RED RD STE 103
BELLEVUE WA
98005-2329
US

V. Phone/Fax

Practice location:
  • Phone: 425-679-5996
  • Fax: 425-968-7590
Mailing address:
  • Phone: 425-679-5996
  • Fax: 425-968-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70116841
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: