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General NPI Number Information
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NPI Number | 1992361000
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Entity Type | Organization
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Legal Business Name | SILVERLAKE CLINIC INC.
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 11419 19TH AVE SE STE C106
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City | EVERETT
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State | WA
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Zip | 98208-5120
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Country | US
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Telephone | 425-523-8878
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Fax | 425-523-8868
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Provider Business Mailing Address
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Address Line | 11419 19TH AVE SE STE C106
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City | EVERETT
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State | WA
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Zip | 98208-5120
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Country | US
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Telephone | 425-523-8878
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Fax | 425-523-8868
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Authorized Official
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Title or Position | OWNER
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Name | JUNGMIN AHN
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Credential | L.AC.
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Telephone | 425-523-8878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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