Healthcare Provider Details

I. General information

NPI: 1366749095
Provider Name (Legal Business Name): RAPHA CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 N 185TH ST STE 202
SHORELINE WA
98133-4011
US

IV. Provider business mailing address

1130 N 185TH ST STE 202
SHORELINE WA
98133-4011
US

V. Phone/Fax

Practice location:
  • Phone: 206-542-1000
  • Fax: 206-542-5353
Mailing address:
  • Phone: 206-542-1000
  • Fax: 206-542-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO00000700
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000700
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO00000700
License Number StateWA

VIII. Authorized Official

Name: JOHN Y JOO
Title or Position: PHYSICIAN/OWNER
Credential: DPM
Phone: 206-542-1000