Healthcare Provider Details

I. General information

NPI: 1013335330
Provider Name (Legal Business Name): KUNAKORN ATCHANEEYASAKUL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-7525
  • Fax: 206-625-7240
Mailing address:
  • Phone: 206-223-7525
  • Fax: 206-625-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD468561
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD61344448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: