Provider Demographics
NPI:1063855690
Name:CORNERSTONE MEDICAL SERVICES FOUNDATION
Entity Type:Organization
Organization Name:CORNERSTONE MEDICAL SERVICES FOUNDATION
Other - Org Name:CORNERSTONE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAI
Authorized Official - Middle Name:JUN
Authorized Official - Last Name:BYEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-689-6268
Mailing Address - Street 1:200 S 333RD ST
Mailing Address - Street 2:STE. 140
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7359
Mailing Address - Country:US
Mailing Address - Phone:253-252-2095
Mailing Address - Fax:
Practice Address - Street 1:200 S 333RD ST
Practice Address - Street 2:STE. 140
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7359
Practice Address - Country:US
Practice Address - Phone:253-252-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-13
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center