Healthcare Provider Details

I. General information

NPI: 1669430948
Provider Name (Legal Business Name): HUONG T LAKIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HUONG T WOOTEN DO

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 WOODLAND SQUARE LOOP SE
LACEY WA
98503-1038
US

IV. Provider business mailing address

669 WOODLAND SQUARE LOOP SE
LACEY WA
98503-1038
US

V. Phone/Fax

Practice location:
  • Phone: 360-359-4840
  • Fax: 360-359-4850
Mailing address:
  • Phone: 360-359-4840
  • Fax: 360-359-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001767
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: