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General NPI Number Information
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NPI Number | 1801759824
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Entity Type | Organization
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Legal Business Name | LYNNWOOD INTEGRATIVE ACUPUNCTURE CLINIC LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 4620 200TH ST SW STE A
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City | LYNNWOOD
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State | WA
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Zip | 98036-6607
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Country | US
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Telephone | 425-672-2838
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Fax | 425-672-2988
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Provider Business Mailing Address
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Address Line | 4620 200TH ST SW STE A
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City | LYNNWOOD
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State | WA
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Zip | 98036-6607
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Country | US
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Telephone | 425-672-2838
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Fax | 425-672-2988
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Authorized Official
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Title or Position | MANAGER
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Name | GUMTHORN PUNCHAANON
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Credential |
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Telephone | 714-916-8705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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