MEDICARE: KHWANSIRI JONGWIWATTHAM L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	17517	WA

General Provider Information

NPI Number	:	1083140008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHWANSIRI JONGWIWATTHAM L.AC

Provider Business Mailing Address
First Line	:	4620 200TH ST SW STE A
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-6607
Country	:	US
Telephone Number	:	425-672-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	4620 200TH ST SW STE A
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-6607
Country	:	US
Telephone Number	:	425-672-2838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	03/05/2026

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Directions to “ KHWANSIRI JONGWIWATTHAM L.AC” Practice Location

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