Healthcare Provider Details

I. General information

NPI: 1275883449
Provider Name (Legal Business Name): YAN SATIK CHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 194TH SW AVE.
BOTHELL WA
98012-6299
US

IV. Provider business mailing address

112 194TH SW AVE.
BOTHELL WA
98012-6299
US

V. Phone/Fax

Practice location:
  • Phone: 425-218-1893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC600174375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: