Healthcare Provider Details

I. General information

NPI: 1215199310
Provider Name (Legal Business Name): YIN AND YANG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 S TACOMA WAY STE 104
LAKEWOOD WA
98499-4595
US

IV. Provider business mailing address

1514 S ADAMS ST
TACOMA WA
98405-2025
US

V. Phone/Fax

Practice location:
  • Phone: 253-678-1212
  • Fax: 253-581-2444
Mailing address:
  • Phone: 253-678-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMA00023490
License Number StateWA

VIII. Authorized Official

Name: MRS. KYONG CHA URBON
Title or Position: PRESIDENT
Credential: MA 00023490 LMP
Phone: 253-678-1212