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NPI Code Detail

MEDICARE: MS. SOONBOK KU SUDP

MEDICARE: MS. SOONBOK KU SUDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorWA

General Provider Information

NPI Number : 1982390498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SOONBOK KU SUDP
Provider Business Mailing Address
First Line : 9100 BRIDGEPORT WAY SW
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-2427
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9100 BRIDGEPORT WAY SW
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-2427
Country : US
Telephone Number : 253-302-3826
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2023
Last Update Date : 04/17/2023

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