Provider Demographics
NPI:1720725773
Name:THRONGKITPAISAN, THANADEJ (LAC)
Entity Type:Individual
Prefix:
First Name:THANADEJ
Middle Name:
Last Name:THRONGKITPAISAN
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 1:5128 KEYSTONE PL N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6232
Mailing Address - Country:US
Mailing Address - Phone:425-954-6639
Mailing Address - Fax:
Practice Address - Street 1:18528 FIRLANDS WAY N STE C
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3985
Practice Address - Country:US
Practice Address - Phone:425-954-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61287888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist