MEDICARE: MRS. AVIGAIL VAN DEN HOF 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	AC00002285	WA

General Provider Information

NPI Number	:	1790855765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AVIGAIL VAN DEN HOF L.AC.

Provider Business Mailing Address
First Line	:	11553 35TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5615
Country	:	US
Telephone Number	:	206-491-7746
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 NW 85TH ST
Second Line	:	SUITE 3
City	:	SEATTLE
State	:	WA
Zip	:	98117-4237
Country	:	US
Telephone Number	:	206-491-7746
Fax Number	:

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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