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General NPI Number Information
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NPI Number | 1093002172
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Entity Type | Individual
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Provider Name | KANYAKANIT BUPPAWONG DEPAZ LMP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 14850 LAKE HILLS BLVD # 4
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City | BELLEVUE
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State | WA
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Zip | 98007-5800
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Country | US
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Telephone | 425-558-9441
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Fax |
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Provider Business Mailing Address
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Address Line | 308 146TH PL NE
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City | BELLEVUE
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State | WA
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Zip | 98007-4941
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Country | US
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Telephone | 206-235-5557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA 00024931
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License Number State | WA
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