Healthcare Provider Details

I. General information

NPI: 1710168125
Provider Name (Legal Business Name): LONDON HOUSE HAIR DESIGNS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13028 1ST AVE S
BURIEN WA
98168-2621
US

IV. Provider business mailing address

13028 1ST AVE S
BURIEN WA
98168-2621
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-3006
  • Fax: 206-244-8813
Mailing address:
  • Phone: 206-244-3006
  • Fax: 206-244-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17080
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number17080
License Number StateWA

VIII. Authorized Official

Name: MRS. KARI RENEE MILLER
Title or Position: OWNER
Credential:
Phone: 206-244-3006