Basic Information
Provider Information
NPI: 1184027666
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YOO
FirstName: SEJANA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: B.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 E OLIVE ST
Address2:  
City: SEATTLE
State: WA
PostalCode: 981222735
CountryCode: US
TelephoneNumber: 2063022200
FaxNumber: 2063022100
Practice Location
Address1: 4238 AUBURN WAY N
Address2:  
City: AUBURN
State: WA
PostalCode: 980021311
CountryCode: US
TelephoneNumber: 2538767600
FaxNumber: 2538767610
Other Information
ProviderEnumerationDate: 09/29/2014
LastUpdateDate: 09/29/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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