Healthcare Provider Details

I. General information

NPI: 1780165548
Provider Name (Legal Business Name): JON KEN OKAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HARBOR AVE SW
SEATTLE WA
98126-2394
US

IV. Provider business mailing address

2440 FOREST RIDGE DR SE
AUBURN WA
98002-7097
US

V. Phone/Fax

Practice location:
  • Phone: 206-697-5001
  • Fax:
Mailing address:
  • Phone: 206-697-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00010380
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: