Provider Demographics
NPI:1508804147
Name:SOUND SLEEP CLINIC, PLLC
Entity Type:Organization
Organization Name:SOUND SLEEP CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKDEK
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOMBORIRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-683-8544
Mailing Address - Street 1:PO BOX 11648
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5648
Mailing Address - Country:US
Mailing Address - Phone:360-344-3701
Mailing Address - Fax:360-344-3702
Practice Address - Street 1:9638 NE LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1115
Practice Address - Country:US
Practice Address - Phone:360-344-3701
Practice Address - Fax:360-344-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB35989Medicare UPIN
WAGAB35989Medicare ID - Type Unspecified