MEDICARE: MR. BENJAMIN BOONCHAI APICHAI EAMP

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	AC 381	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548AP	OTHER	WA	BLUE SHIELD # VM
2	US5069591	OTHER	WA	AETNA PCP PIN VM

General Provider Information

NPI Number	:	1508905720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN BOONCHAI APICHAI EAMP

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	:
Name	:
Credential	:
Telephone Number	:

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

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Directions to “ MR. BENJAMIN BOONCHAI APICHAI EAMP” Practice Location

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