Provider Demographics
NPI:1932550183
Name:PHC - CHARM ZONE ASIAN MEDICINE CLINIC
Entity Type:Organization
Organization Name:PHC - CHARM ZONE ASIAN MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, OMD
Authorized Official - Phone:206-960-3308
Mailing Address - Street 1:8730 S TACOMA WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4521
Mailing Address - Country:US
Mailing Address - Phone:866-778-9191
Mailing Address - Fax:253-815-8772
Practice Address - Street 1:8730 S TACOMA WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4521
Practice Address - Country:US
Practice Address - Phone:866-778-9191
Practice Address - Fax:253-815-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60493370171100000X
WAAC00000376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty