Healthcare Provider Details

I. General information

NPI: 1679769103
Provider Name (Legal Business Name): CHAYA JOIE KUDLA LAC, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10171 CHUMSTICK HWY SUITE A
LEAVENWORTH WA
98826-9267
US

IV. Provider business mailing address

227 BELLEVUE WAY NE 438
BELLEVUE WA
98004-5721
US

V. Phone/Fax

Practice location:
  • Phone: 509-782-0448
  • Fax:
Mailing address:
  • Phone: 425-454-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002858
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: