Provider Demographics
NPI:1578951653
Name:WANG, FAITH SHAO (LMT)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:SHAO
Last Name:WANG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SHAO
Other - Middle Name:RONG
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:9015 HOLMAN RD NW STE 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3481
Mailing Address - Country:US
Mailing Address - Phone:206-782-8500
Mailing Address - Fax:206-784-4020
Practice Address - Street 1:18421 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037
Practice Address - Country:US
Practice Address - Phone:425-582-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-25
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60514555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60514555Medicaid