Provider Demographics
NPI:1609559020
Name:LEW, SEUNG
Entity Type:Individual
Prefix:
First Name:SEUNG
Middle Name:
Last Name:LEW
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 1:9010 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-4908
Mailing Address - Country:US
Mailing Address - Phone:425-334-2100
Mailing Address - Fax:
Practice Address - Street 1:9010 MARKET PL
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-4908
Practice Address - Country:US
Practice Address - Phone:425-334-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61464913183500000X
WAIR60980718390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program