MEDICARE: SEONG IL YI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA61114886	WA

General Provider Information

NPI Number	:	1740869924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEONG IL YI

Provider Business Mailing Address
First Line	:	4868 OSPREY LN
Second Line	:
City	:	MUKILTEO
State	:	WA
Zip	:	98275-5465
Country	:	US
Telephone Number	:	702-788-8579
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 164TH ST SW STE 203
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98087-7811
Country	:	US
Telephone Number	:	425-245-7122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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Directions to “ SEONG IL YI ” Practice Location

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