Provider Demographics
NPI:1114042447
Name:HANMI MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:HANMI MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOO
Authorized Official - Middle Name:KEUN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-581-4564
Mailing Address - Street 1:9115 S TACOMA WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4400
Mailing Address - Country:US
Mailing Address - Phone:253-581-4564
Mailing Address - Fax:253-581-6484
Practice Address - Street 1:9115 S TACOMA WAY STE 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4400
Practice Address - Country:US
Practice Address - Phone:253-581-4564
Practice Address - Fax:253-581-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA22482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020536Medicaid
WAAO8701Medicare UPIN
WA001001440Medicare ID - Type Unspecified