Provider Demographics
NPI:1508905720
Name:APICHAI, BENJAMIN BOONCHAI (EAMP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:BOONCHAI
Last Name:APICHAI
Suffix:
Gender:M
Credentials:EAMP
Other - Prefix:MR
Other - First Name:BOONCHAI
Other - Middle Name:
Other - Last Name:APIRAKCHAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:11345 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6858
Mailing Address - Country:US
Mailing Address - Phone:206-289-0303
Mailing Address - Fax:
Practice Address - Street 1:12025 LAKE CITY WAY NE STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5331
Practice Address - Country:US
Practice Address - Phone:206-289-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1548APOtherBLUE SHIELD # VM
WAUS5069591OtherAETNA PCP PIN VM