Healthcare Provider Details

I. General information

NPI: 1245383389
Provider Name (Legal Business Name): RICHARD JACK KITAEFF N.D., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23700 EDMONDS WAY
EDMONDS WA
98026-8978
US

IV. Provider business mailing address

23700 EDMONDS WAY
EDMONDS WA
98026-8978
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-6001
  • Fax: 425-776-7119
Mailing address:
  • Phone: 425-775-6001
  • Fax: 425-776-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000007
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00000507
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: