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General NPI Number Information
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NPI Number | 1124366596
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Entity Type | Individual
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Provider Name | BRIAN B BACUNGAN LMP
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Gender | Male
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Dates
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Enumeration Date | 01/19/2013
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 2208 NW MARKET ST 430B
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City | SEATTLE
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State | WA
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Zip | 98107-4030
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Country | US
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Telephone | 808-232-8098
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Fax |
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Provider Business Mailing Address
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Address Line | 15433 COUNTRY CLUB DR A103
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City | MILL CREEK
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State | WA
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Zip | 98012-1260
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Country | US
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Telephone | 808-232-8098
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 60320042
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License Number State | WA
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