Basic Information
| Provider Information | |||||||||
| NPI: | 1811447329 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AESTHETIC ALCHEMY PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 97115 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984970115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535887911 | ||||||||
| FaxNumber: | 2533656299 | ||||||||
| Practice Location | |||||||||
| Address1: | 2603 BRIDGEPORT WAY W | ||||||||
| Address2: | SUITE F | ||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535644073 | ||||||||
| FaxNumber: | 2535660219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2016 | ||||||||
| LastUpdateDate: | 10/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | YOKOYAMA | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2535644073 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD00024872 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | MD00024872 | 01 | WA | LICENSE | OTHER |