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General NPI Number Information
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NPI Number | 1386788537
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Entity Type | Organization
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Legal Business Name | NORTHWEST FAMILY CARE CLINIC PLLC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5203 LACEY BLVD SE SUITE A
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City | LACEY
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State | WA
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Zip | 98503-7236
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Country | US
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Telephone | 360-413-8447
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Fax | 360-413-8493
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Provider Business Mailing Address
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Address Line | 5203 LACEY BLVD SE SUITE A
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City | LACEY
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State | WA
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Zip | 98503-7236
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Country | US
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Telephone | 360-413-8447
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Fax | 360-413-8493
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Authorized Official
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Title or Position | PHYSICIAN
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Name | HUONG THI LAKIN
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Credential | D.O.
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Telephone | 360-413-8447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00001767
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License Number State | WA
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