Healthcare Provider Details

I. General information

NPI: 1477019487
Provider Name (Legal Business Name): ASFAW CHURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 12/10/2025
Certification Date:
Deactivation Date: 09/25/2025
Reactivation Date: 12/10/2025

III. Provider practice location address

1701 18TH AVE S
SEATTLE WA
98144-4317
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7444
  • Fax:
Mailing address:
  • Phone: 253-833-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60546393
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: