Provider Demographics
NPI:1518650167
Name:GUAN, JUNHUA (MA 61275237)
Entity Type:Individual
Prefix:
First Name:JUNHUA
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:MA 61275237
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 NE 70TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3882
Mailing Address - Country:US
Mailing Address - Phone:360-947-7586
Mailing Address - Fax:
Practice Address - Street 1:3200 SE 164TH AVE STE 218
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1108
Practice Address - Country:US
Practice Address - Phone:360-737-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61275237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist