Provider Demographics
NPI:1093215170
Name:KENG, MANDY (LAC)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:KENG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17401 135TH AVE NE STE 6
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17401 135TH AVE NE STE 6
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6825
Practice Address - Country:US
Practice Address - Phone:425-219-9500
Practice Address - Fax:425-296-4903
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist