Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00022102 | WA |
NPI | 1003958679 |
---|---|
Provider Name | Mr. Donald Chin |
First Address | Federal Way, WA 98003-3334 |
Second Address | Federal Way, WA 98003-3334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 30/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0206221 | DEPT. OF L& I (01) | WA |
612017600 | DOL FECA (OWCP) (01) | WA |