Provider Demographics
NPI:1922305556
Name:SOK, PHALLA
Entity Type:Individual
Prefix:MRS
First Name:PHALLA
Middle Name:
Last Name:SOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23928 109TH AVE SE APT 2D303
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5822
Mailing Address - Country:US
Mailing Address - Phone:206-794-4504
Mailing Address - Fax:
Practice Address - Street 1:6951 MARTIN LUTHER KING JR WAY S STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3545
Practice Address - Country:US
Practice Address - Phone:206-721-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60191695225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist