Provider Demographics
NPI:1558575282
Name:CHUNG SONG JA CORP
Entity Type:Organization
Organization Name:CHUNG SONG JA CORP
Other - Org Name:NORTH SEATTLE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAE HYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:425-637-2000
Mailing Address - Street 1:1220 116TH AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3826
Mailing Address - Country:US
Mailing Address - Phone:425-637-2000
Mailing Address - Fax:
Practice Address - Street 1:1220 116TH AVE NE STE 203
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3826
Practice Address - Country:US
Practice Address - Phone:425-637-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty