Healthcare Provider Details

I. General information

NPI: 1528196052
Provider Name (Legal Business Name): CHRISTIAN FAMILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33507 9TH AVE S BUILDING A
FEDERAL WAY WA
98003-6397
US

IV. Provider business mailing address

8511 SOUTH TACOMA WAY #200
TACOMA WA
98499
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-5404
  • Fax: 253-874-8964
Mailing address:
  • Phone: 253-588-4015
  • Fax: 253-588-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD00029607
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006909
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006915
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006808
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60126966
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00044106
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00029607
License Number StateWA

VIII. Authorized Official

Name: YOUNG H LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 253-874-5404