Provider Demographics
NPI:1568493583
Name:RUNGRUANGKONKIT, SANGJAN (ARNP)
Entity Type:Individual
Prefix:
First Name:SANGJAN
Middle Name:
Last Name:RUNGRUANGKONKIT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:RUNGRUANGKONKIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:BOX 359797
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2499
Mailing Address - Country:US
Mailing Address - Phone:206-744-9600
Mailing Address - Fax:206-744-9920
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2499
Practice Address - Country:US
Practice Address - Phone:206-744-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003912363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA02545UOtherREGENCE BLUE SHIELD PIN
WA9618083Medicaid
WAAB18822Medicare PIN
WA02545UOtherREGENCE BLUE SHIELD PIN