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General NPI Number Information
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NPI Number | 1508804147
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Entity Type | Organization
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Legal Business Name | SOUND SLEEP CLINIC, PLLC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 9638 NE LAFAYETTE AVE
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-1115
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Country | US
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Telephone | 360-344-3701
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Fax | 360-344-3702
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Provider Business Mailing Address
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Address Line | PO BOX 11648
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-5648
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Country | US
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Telephone | 360-344-3701
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Fax | 360-344-3702
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAKDEK NIKOMBORIRAK
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Credential | MD
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Telephone | 360-683-8544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00036445
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License Number State | WA
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