Provider Demographics
NPI:1740064849
Name:MINT THAI MASSAGE LLC
Entity type:Organization
Organization Name:MINT THAI MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NAMFON
Authorized Official - Middle Name:
Authorized Official - Last Name:KANPHAI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT & MMP
Authorized Official - Phone:425-502-0496
Mailing Address - Street 1:25326 128TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6605
Mailing Address - Country:US
Mailing Address - Phone:425-502-0496
Mailing Address - Fax:
Practice Address - Street 1:25326 128TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6605
Practice Address - Country:US
Practice Address - Phone:425-502-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty