Healthcare Provider Details

I. General information

NPI: 1609559020
Provider Name (Legal Business Name): SEUNG LEW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 MARKET PL
LAKE STEVENS WA
98258-4908
US

IV. Provider business mailing address

9010 MARKET PL
LAKE STEVENS WA
98258-4908
US

V. Phone/Fax

Practice location:
  • Phone: 425-334-2100
  • Fax:
Mailing address:
  • Phone: 425-334-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberIR60980718
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61464913
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: