=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659672863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC FAMILY WELLNESS CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2010
-----------------------------------------------------
Last Update Date | 11/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 116TH AVE NE STE 200
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-954-6225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 116TH AVE NE STE 200
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NATUROPATH
-----------------------------------------------------
Name | AKIKO KATO
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 206-853-1242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | NT60184218
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------