| LCA CASE NUMBER | I-200-21165-396571 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-06-14 |
| DECISION DATE | 2021-06-22 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Nurse Practitioner |
| SOC CODE | 29-1171.00 |
| SOC TITLE | Nurse Practitioners |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-10-01 |
| END DATE | 2024-09-30 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Family Medicine Clinic of Federal Way, LLC |
| TRADE NAME DBA | Family Medicine Clinic of Federal Way |
| EMPLOYER ADDRESS1 | 34618 11th PL S |
| EMPLOYER ADDRESS2 | Suite 100 |
| EMPLOYER CITY | Federal Way |
| EMPLOYER STATE | WA |
| EMPLOYER POSTAL CODE | 98003 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 12533311334 |
| NAICS CODE | 621111 |
| EMPLOYER POC LAST NAME | Leng |
| EMPLOYER POC FIRST NAME | Vuthy |
| EMPLOYER POC JOB TITLE | Governor and Physician |
| EMPLOYER POC ADDRESS 1 | 34618 11th PL S |
| EMPLOYER POC ADDRESS 2 | Suite 100 |
| EMPLOYER POC CITY | Federal Way |
| EMPLOYER POC STATE | WA |
| EMPLOYER POC POSTAL CODE | 98003 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 12062146007 |
| EMPLOYER POC EMAIL | vuthy@lengmd.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Kim |
| AGENT ATTORNEY FIRST NAME | Wangjin |
| AGENT ATTORNEY ADDRESS1 | 11555 SE 8th St |
| AGENT ATTORNEY ADDRESS2 | Suite 120 |
| AGENT ATTORNEY CITY | Bellevue |
| AGENT ATTORNEY STATE | WA |
| AGENT ATTORNEY POSTAL CODE | 98004 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 14254400220 |
| AGENT ATTORNEY EMAIL ADDRESS | wkim@jklawgroup.com |
| LAWFIRM NAME BUSINESS NAME | JK Law Group |
| STATE OF HIGHEST COURT | WA |
| NAME OF HIGHEST STATE COURT | Washington State Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 34618 11th PL S |
| WORKSITE ADDRESS2 | Suite 100 |
| LCA CASE WORKLOC1 CITY | Federal Way |
| WORKSITE COUNTY | KING |
| LCA CASE WORKLOC1 STATE | WA |
| WORKSITE POSTAL CODE | 98003 |
| LCA CASE WAGE RATE FROM | 100000 |
| LCA CASE WAGE RATE TO | 130000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 99674 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business and Employment |
