Provider Demographics
NPI:1861475543
Name:JORGENSEN, KAIRA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:KAIRA
Middle Name:MARIE
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 NE 127TH CT
Mailing Address - Street 2:#A8
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7613
Mailing Address - Country:US
Mailing Address - Phone:425-770-4811
Mailing Address - Fax:
Practice Address - Street 1:16120 NE 87TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3505
Practice Address - Country:US
Practice Address - Phone:425-885-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-27
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002615171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist