Healthcare Provider Details

I. General information

NPI: 1124881602
Provider Name (Legal Business Name): FEDERAL WAY AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34709 9TH AVE S STE B200
FEDERAL WAY WA
98003-8724
US

IV. Provider business mailing address

34709 9TH AVE S STE B200
FEDERAL WAY WA
98003-8724
US

V. Phone/Fax

Practice location:
  • Phone: 253-248-6106
  • Fax:
Mailing address:
  • Phone: 253-248-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. YEASEL CHAE
Title or Position: CEO
Credential: AU.D.
Phone: 253-248-6106