Provider Demographics
NPI:1821616384
Name:EASTSIDE GENTLE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:EASTSIDE GENTLE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE COMPANY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROKHSAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:425-638-9098
Mailing Address - Street 1:14120 NE 183RD ST # 1-410
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-7070
Mailing Address - Country:US
Mailing Address - Phone:425-638-9098
Mailing Address - Fax:
Practice Address - Street 1:1427 228TH ST SE STE D1
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7407
Practice Address - Country:US
Practice Address - Phone:425-835-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty