Healthcare Provider Details

I. General information

NPI: 1366739955
Provider Name (Legal Business Name): WEN CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18205 ALDERWOOD MALL PKWY STE K
LYNNWOOD WA
98037-3913
US

IV. Provider business mailing address

18205 ALDERWOOD MALL PKWY STE K
LYNNWOOD WA
98037-3913
US

V. Phone/Fax

Practice location:
  • Phone: 425-778-1188
  • Fax:
Mailing address:
  • Phone: 425-778-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60229652
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: