Healthcare Provider Details

I. General information

NPI: 1649145749
Provider Name (Legal Business Name): GRACE MINDCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34509 9TH AVE S STE 104
FEDERAL WAY WA
98003-8707
US

IV. Provider business mailing address

617 EASTLAKE AVE E STE 410
SEATTLE WA
98109-5681
US

V. Phone/Fax

Practice location:
  • Phone: 206-312-5373
  • Fax: 800-259-2457
Mailing address:
  • Phone: 206-312-5373
  • Fax: 206-259-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NAKYUNG CHOE
Title or Position: COO
Credential:
Phone: 206-207-2310