MEDICARE: BOONCHAI CORPORATION

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	AC381	WA

General Provider Information

NPI Number	:	1316085509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOONCHAI CORPORATION

Provider Business Mailing Address
First Line	:	11345 30TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6858
Country	:	US
Telephone Number	:	206-289-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	12025 LAKE CITY WAY NE STE B
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5331
Country	:	US
Telephone Number	:	206-289-0303
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BENJAMIN BOONCHAI APICHAI
Credential	:	EAMP
Telephone Number	:	206-289-0303

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	05/17/2018

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Directions to “BOONCHAI CORPORATION ” Practice Location

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