Provider Demographics
NPI:1245535327
Name:KING, SOPHIE KAORU (LMP, C,HT)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:KAORU
Last Name:KING
Suffix:
Gender:F
Credentials:LMP, C,HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 38TH DR SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4280
Mailing Address - Country:US
Mailing Address - Phone:602-799-1435
Mailing Address - Fax:
Practice Address - Street 1:16825 48TH AVE W STE 125
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6402
Practice Address - Country:US
Practice Address - Phone:602-799-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60204100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist