Healthcare Provider Details

I. General information

NPI: 1346002045
Provider Name (Legal Business Name): SUANG SAETURN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19065 85TH AVE NE
BOTHELL WA
98011-2133
US

IV. Provider business mailing address

19065 85TH AVE NE
BOTHELL WA
98011-2133
US

V. Phone/Fax

Practice location:
  • Phone: 425-496-0025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: