Healthcare Provider Details

I. General information

NPI: 1124341789
Provider Name (Legal Business Name): KUO CHIANG YEE LAC PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 130TH ST SE #202, NEUROSCIENCE MEDICAL CENTER
EVERETT WA
98208
US

IV. Provider business mailing address

125 130TH ST SE #202, NEUROSCIENCE MEDICAL CENTER
EVERETT WA
98208
US

V. Phone/Fax

Practice location:
  • Phone: 425-357-8964
  • Fax: 425-379-2624
Mailing address:
  • Phone: 425-357-8964
  • Fax: 425-379-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC0G
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: