Healthcare Provider Details

I. General information

NPI: 1588207039
Provider Name (Legal Business Name): KOREAN WOMEN'S ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E 96TH ST
TACOMA WA
98445-2001
US

IV. Provider business mailing address

123 E 96TH ST
TACOMA WA
98445-2001
US

V. Phone/Fax

Practice location:
  • Phone: 425-591-2331
  • Fax:
Mailing address:
  • Phone: 425-591-2331
  • Fax: 253-535-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HWA JA LEE
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 253-538-8341