Provider Demographics
NPI:1033358551
Name:BUKOVCAN, SAMYAR STANISLAV (ND)
Entity Type:Individual
Prefix:DR
First Name:SAMYAR
Middle Name:STANISLAV
Last Name:BUKOVCAN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3021
Mailing Address - Country:US
Mailing Address - Phone:425-451-0404
Mailing Address - Fax:425-462-8919
Practice Address - Street 1:1899 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3021
Practice Address - Country:US
Practice Address - Phone:425-451-0404
Practice Address - Fax:425-462-8919
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60065507175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath