Healthcare Provider Details

I. General information

NPI: 1043931074
Provider Name (Legal Business Name): IRINA MIKHAYLOVNA KHARCHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25854 108TH AVE SE
KENT WA
98030-7737
US

IV. Provider business mailing address

10735 SE 184TH LN
RENTON WA
98055-8434
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: