Basic Information
| Provider Information | |||||||||
| NPI: | 1295934438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAPHA CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1207 N 200TH ST | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981333213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065425323 | ||||||||
| FaxNumber: | 2065469596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1207 N 200TH ST | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981333213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065425323 | ||||||||
| FaxNumber: | 2065469596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | JOO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2065425323 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.