Provider Demographics
NPI:1427214907
Name:HAHN, MARK E (LMP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HAHN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17430 AMBAUM BLVD S
Mailing Address - Street 2:#5
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1751
Mailing Address - Country:US
Mailing Address - Phone:206-307-4238
Mailing Address - Fax:
Practice Address - Street 1:17430 AMBAUM BLVD S
Practice Address - Street 2:#5
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1751
Practice Address - Country:US
Practice Address - Phone:206-307-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60034418225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist