Provider Demographics
NPI:1407252323
Name:HONG, SOONMOK
Entity Type:Individual
Prefix:
First Name:SOONMOK
Middle Name:
Last Name:HONG
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 1:505 121ST PL NE
Mailing Address - Street 2:A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3161
Mailing Address - Country:US
Mailing Address - Phone:425-451-4446
Mailing Address - Fax:
Practice Address - Street 1:2025 112TH AVE NE
Practice Address - Street 2:BELLEWOOD BLDG.TWO, SUITE 100 RM4
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2943
Practice Address - Country:US
Practice Address - Phone:425-451-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60424303171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPIA-539578OtherAMERICAN ACUPUNCTUR​E COUNCIL