MEDICARE: LYNNWOOD INTEGRATIVE ACUPUNCTURE CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1801759824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNNWOOD INTEGRATIVE ACUPUNCTURE CLINIC LLC

Provider Business Mailing Address
First Line	:	4620 200TH ST SW STE A
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-6607
Country	:	US
Telephone Number	:	425-672-2838
Fax Number	:	425-672-2988

Provider Business Practice Location Address
First Line	:	4620 200TH ST SW STE A
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-6607
Country	:	US
Telephone Number	:	425-672-2838
Fax Number	:	425-672-2988

Authorized Official
Title or Position	:	MANAGER
Name	:	GUMTHORN PUNCHAANON
Credential	:
Telephone Number	:	714-916-8705

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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