Healthcare Provider Details

I. General information

NPI: 1134267677
Provider Name (Legal Business Name): YAKOV KHESIN LMP-C, NCTMB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JACOB KHESIN LMP-C, NCTMB

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N 115TH ST STE 207
SEATTLE WA
98133-8411
US

IV. Provider business mailing address

1530 N 115TH ST STE 207
SEATTLE WA
98133-8411
US

V. Phone/Fax

Practice location:
  • Phone: 206-355-6781
  • Fax: 206-523-1252
Mailing address:
  • Phone: 206-355-6781
  • Fax: 206-523-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00010390
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: