Provider Demographics
NPI:1518043181
Name:AN, YOUNGWUK (DC)
Entity Type:Individual
Prefix:
First Name:YOUNGWUK
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6951 MARTIN LUTHER KING JR WAY S
Mailing Address - Street 2:#101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3597
Mailing Address - Country:US
Mailing Address - Phone:206-721-7200
Mailing Address - Fax:206-339-7200
Practice Address - Street 1:6951 MARTIN LUTHER KING JR WAY S
Practice Address - Street 2:#101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3597
Practice Address - Country:US
Practice Address - Phone:206-721-7200
Practice Address - Fax:206-339-7200
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60064547111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4707680Medicaid
MI4707680Medicaid