Provider Demographics
NPI:1457076580
Name:BOOI, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BOOI
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 1:636 CALIFORNIA WAY UNIT 193
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-1641
Mailing Address - Country:US
Mailing Address - Phone:360-846-7398
Mailing Address - Fax:
Practice Address - Street 1:636 CALIFORNIA WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1651
Practice Address - Country:US
Practice Address - Phone:360-846-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider