Provider Demographics
NPI:1578779344
Name:URBON, KYONG CHA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KYONG
Middle Name:CHA
Last Name:URBON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2025
Mailing Address - Country:US
Mailing Address - Phone:253-678-1212
Mailing Address - Fax:
Practice Address - Street 1:1514 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2025
Practice Address - Country:US
Practice Address - Phone:253-678-1212
Practice Address - Fax:253-581-2444
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023490225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist