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General NPI Number Information
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NPI Number | 1255994935
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Entity Type | Organization
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Legal Business Name | JET CITY ACUPUNCTURE & WELLNESS, PLLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 5130 15TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98108-2316
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Country | US
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Telephone | 360-286-4407
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Fax |
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Provider Business Mailing Address
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Address Line | 5130 15TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98108-2316
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Country | US
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Telephone | 360-286-4407
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER, OWNER
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Name | MY NHUNG PHAM KOLB
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Credential | LAC, EAMP
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Telephone | 360-286-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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