Healthcare Provider Details

I. General information

NPI: 1649875436
Provider Name (Legal Business Name): GRACE PAIK RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE PAIK RDN

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16404 SMOKEY POINT BLVD SUITE 308
ARLINGTON WA
98223-8417
US

IV. Provider business mailing address

12 BELLWETHER WAY STE 223
BELLINGHAM WA
98225-2914
US

V. Phone/Fax

Practice location:
  • Phone: 360-230-8202
  • Fax: 360-682-3732
Mailing address:
  • Phone: 360-230-8202
  • Fax: 360-682-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: