Provider Demographics
NPI:1366749095
Name:RAPHA CLINICS, INC
Entity type:Organization
Organization Name:RAPHA CLINICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JOO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-542-1000
Mailing Address - Street 1:1130 N 185TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4011
Mailing Address - Country:US
Mailing Address - Phone:206-542-1000
Mailing Address - Fax:206-542-5353
Practice Address - Street 1:1130 N 185TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4011
Practice Address - Country:US
Practice Address - Phone:206-542-1000
Practice Address - Fax:206-542-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000700213EP1101X, 213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB36982OtherMEDICARE PTAN
WAGAB36984OtherMEDICARE PTAN
WA115773Medicaid
GAB36981OtherMEDICARE PTAN
WAGAB36983OtherMEDICARE PTAN