Provider Demographics
NPI:1356486625
Name:BALANGUE, YAOWANIT (DI)
Entity Type:Individual
Prefix:
First Name:YAOWANIT
Middle Name:
Last Name:BALANGUE
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:YAOWANIT
Other - Middle Name:
Other - Last Name:DENWONGKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DI
Mailing Address - Street 1:955 POWELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2908
Mailing Address - Country:US
Mailing Address - Phone:425-277-1311
Mailing Address - Fax:425-277-1566
Practice Address - Street 1:200 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2011
Practice Address - Country:US
Practice Address - Phone:425-266-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001879133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist