Healthcare Provider Details

I. General information

NPI: 1821311259
Provider Name (Legal Business Name): SOKUN KOTH LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 103RD AVE NE SUITE A
BELLEVUE WA
98004-5689
US

IV. Provider business mailing address

37 103RD AVE NE SUITE A
BELLEVUE WA
98004-5689
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-1171
  • Fax: 425-451-1232
Mailing address:
  • Phone: 425-451-1171
  • Fax: 425-451-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60137179
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: