Provider Demographics
NPI:1316636400
Name:EZER ART STUDIO LLC
Entity type:Organization
Organization Name:EZER ART STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HYUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-355-5338
Mailing Address - Street 1:17806 30TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17806 30TH DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6654
Practice Address - Country:US
Practice Address - Phone:206-355-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty