Healthcare Provider Details

I. General information

NPI: 1174880306
Provider Name (Legal Business Name): ELIZABETH DART DAOM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 NW GILMAN BLVD STE 1D
ISSAQUAH WA
98027-5329
US

IV. Provider business mailing address

580 FRONT ST S UNIT A203
ISSAQUAH WA
98027-4276
US

V. Phone/Fax

Practice location:
  • Phone: 425-835-2189
  • Fax:
Mailing address:
  • Phone: 425-324-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number60732558
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: