Healthcare Provider Details

I. General information

NPI: 1568493583
Provider Name (Legal Business Name): SANGJAN RUNGRUANGKONKIT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN RUNGRUANGKONKIT

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

325 9TH AVE BOX 359797
SEATTLE WA
98104-2499
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3000
  • Fax:
Mailing address:
  • Phone: 206-744-9600
  • Fax: 206-744-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30003912
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30003912
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: