Provider Demographics
NPI:1124888193
Name:CAROLS KREATION AND BOUTIQUE LLC
Entity type:Organization
Organization Name:CAROLS KREATION AND BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG HO KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-403-6781
Mailing Address - Street 1:9206 195TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8476
Mailing Address - Country:US
Mailing Address - Phone:206-403-6781
Mailing Address - Fax:
Practice Address - Street 1:18407 PACIFIC AVE S STE 5
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8374
Practice Address - Country:US
Practice Address - Phone:206-403-6781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLS KREATION AND BOUTIQUE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)