Provider Demographics
NPI:1578143681
Name:SO, JIN CHUL
Entity Type:Individual
Prefix:MR
First Name:JIN
Middle Name:CHUL
Last Name:SO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 164TH ST SW APT A107
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-9013
Mailing Address - Country:US
Mailing Address - Phone:425-442-7138
Mailing Address - Fax:
Practice Address - Street 1:4217 164TH ST SW APT A107
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-9013
Practice Address - Country:US
Practice Address - Phone:425-442-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC7822171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter