Healthcare Provider Details

I. General information

NPI: 1982740650
Provider Name (Legal Business Name): SEOUL CHINESE HERBS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8718 S TACOMA WAY SUITE #A-2
LAKEWOOD WA
98499-4597
US

IV. Provider business mailing address

8718 S TACOMA WAY #A-2
LAKEWOOD WA
98499
US

V. Phone/Fax

Practice location:
  • Phone: 253-584-8649
  • Fax: 253-584-0701
Mailing address:
  • Phone: 253-584-8649
  • Fax: 253-584-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000548
License Number StateWA

VIII. Authorized Official

Name: MR. JOHN LEE
Title or Position: ADMINISTRATER
Credential:
Phone: 253-584-8649