Provider Demographics
NPI:1184228736
Name:SEA BREEZE HOLISTIC HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:SEA BREEZE HOLISTIC HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, L.AC., DAOM
Authorized Official - Prefix:DR
Authorized Official - First Name:HAIFENG
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:408-896-3521
Mailing Address - Street 1:2149 SHY BEAR WAY NW APT 410
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5628
Mailing Address - Country:US
Mailing Address - Phone:408-896-3521
Mailing Address - Fax:
Practice Address - Street 1:184 SHY BEAR WAY NW STE B
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5696
Practice Address - Country:US
Practice Address - Phone:425-657-0439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty