Provider Demographics
NPI:1528559416
Name:ORIGINAL QI PLLC
Entity Type:Organization
Organization Name:ORIGINAL QI PLLC
Other - Org Name:PHONEXAY LAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHONEXAY
Authorized Official - Middle Name:LALA
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP, LAC
Authorized Official - Phone:509-554-0516
Mailing Address - Street 1:5401 LEARY AVE NW STE 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4070
Mailing Address - Country:US
Mailing Address - Phone:206-582-3469
Mailing Address - Fax:206-582-3472
Practice Address - Street 1:5401 LEARY AVE NW STE 203
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4070
Practice Address - Country:US
Practice Address - Phone:206-582-3469
Practice Address - Fax:206-582-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60446929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801209457OtherINDIVIDUAL NPI
WAAC60446929OtherSTATE ACUPUNCTURE LICENSE- DOH