Provider Demographics
NPI:1043766751
Name:BAHK, IL-JEA
Entity Type:Individual
Prefix:
First Name:IL-JEA
Middle Name:
Last Name:BAHK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 FIRST AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168
Mailing Address - Country:US
Mailing Address - Phone:206-433-6446
Mailing Address - Fax:
Practice Address - Street 1:14300 FIRST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168
Practice Address - Country:US
Practice Address - Phone:206-433-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60573201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist