=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710743075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TK HEALTH & WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2024
-----------------------------------------------------
Last Update Date | 07/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12721 NE BEL RED RD STE 130
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98005-2653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-484-2548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5830 119TH ST SE
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98296-6967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-770-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF ACUPUNCTURE
-----------------------------------------------------
Name | DR. TAE HO KIM
-----------------------------------------------------
Credential | DAC, EAMP
-----------------------------------------------------
Telephone | 425-770-1888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------