Provider Demographics
NPI:1184174955
Name:OH, SEUNGTAEK (LAC)
Entity type:Individual
Prefix:
First Name:SEUNGTAEK
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31830 PACIFIC HWY S STE B
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5449
Mailing Address - Country:US
Mailing Address - Phone:253-431-8316
Mailing Address - Fax:
Practice Address - Street 1:930 S 336TH ST STE B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6384
Practice Address - Country:US
Practice Address - Phone:253-431-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC6064782171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist