Healthcare Provider Details

I. General information

NPI: 1821616384
Provider Name (Legal Business Name): EASTSIDE GENTLE ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 228TH ST SE STE D1
BOTHELL WA
98021-7407
US

IV. Provider business mailing address

14120 NE 183RD ST # 1-410
WOODINVILLE WA
98072-7070
US

V. Phone/Fax

Practice location:
  • Phone: 425-835-6299
  • Fax:
Mailing address:
  • Phone: 425-638-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROKHSAREH MOHAMMADI
Title or Position: PRESIDENT OF THE COMPANY
Credential: ACUPUNCTURIST
Phone: 425-638-9098