Provider Demographics
NPI:1497456602
Name:HA, SAGE JIHYUN (LAC)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:JIHYUN
Last Name:HA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15230 NE 24TH ST # 1-S
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5540
Mailing Address - Country:US
Mailing Address - Phone:425-827-2225
Mailing Address - Fax:
Practice Address - Street 1:15230 NE 24TH ST # 1-S
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5540
Practice Address - Country:US
Practice Address - Phone:425-827-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61383013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist