Healthcare Provider Details

I. General information

NPI: 1992711717
Provider Name (Legal Business Name): TEERAWONG KASIOLARN N.D., M.S.A., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 K ST NW STE 900
WASHINGTON DC
20006-5349
US

IV. Provider business mailing address

1717 K ST NW STE 900
WASHINGTON DC
20006-5349
US

V. Phone/Fax

Practice location:
  • Phone: 571-207-6768
  • Fax: 202-831-3132
Mailing address:
  • Phone: 571-207-6768
  • Fax: 202-831-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000439
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099-0000244
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP-0041
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: