=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861951188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HYON HYE PAK LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2019
-----------------------------------------------------
Last Update Date | 03/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 136TH ST S
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98444-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-363-1001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 99163
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98496-0163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-363-1001
-----------------------------------------------------
Fax | 253-363-1001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 60777743
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------