Provider Demographics
NPI:1619188901
Name:NGAMSIRIPOL, PRASERT (LAC)
Entity Type:Individual
Prefix:
First Name:PRASERT
Middle Name:
Last Name:NGAMSIRIPOL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 NE 20TH ST STE L
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4901
Mailing Address - Country:US
Mailing Address - Phone:425-641-6861
Mailing Address - Fax:
Practice Address - Street 1:13620 NE 20TH ST STE L
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4901
Practice Address - Country:US
Practice Address - Phone:425-641-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA452171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist