Provider Demographics
NPI:1609071018
Name:JI, SE JUN (DC)
Entity Type:Individual
Prefix:DR
First Name:SE JUN
Middle Name:
Last Name:JI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33305 1ST WAY S STE B104
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4545
Mailing Address - Country:US
Mailing Address - Phone:253-252-2415
Mailing Address - Fax:253-235-5681
Practice Address - Street 1:33305 1ST WAY S STE B104
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4545
Practice Address - Country:US
Practice Address - Phone:253-252-2415
Practice Address - Fax:253-235-5681
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5996111N00000X
OR4142175F00000X
WACH60169609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath