Provider Demographics
NPI:1295934438
Name:RAPHA CLINIC INC
Entity type:Organization
Organization Name:RAPHA CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JOO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-542-5323
Mailing Address - Street 1:1130 N 185TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4011
Mailing Address - Country:US
Mailing Address - Phone:206-542-1000
Mailing Address - Fax:206-542-5353
Practice Address - Street 1:1130 N 185TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4011
Practice Address - Country:US
Practice Address - Phone:206-542-1000
Practice Address - Fax:206-542-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB36984Medicare PIN
WAU84791Medicare UPIN
WA5311450001Medicare NSC
WAGAB36983Medicare PIN