Provider Demographics
NPI:1528114394
Name:AUDREY M.K. YAN
Entity type:Organization
Organization Name:AUDREY M.K. YAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:MK
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-854-1823
Mailing Address - Street 1:9620 S. 203RD STREET
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031
Mailing Address - Country:US
Mailing Address - Phone:253-854-1823
Mailing Address - Fax:253-854-1823
Practice Address - Street 1:24604 104TH AVE SE # 203
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4965
Practice Address - Country:US
Practice Address - Phone:253-859-2373
Practice Address - Fax:253-856-8754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty