Provider Demographics
NPI:1619647559
Name:KUANKITPAISAN, PIYADA
Entity type:Individual
Prefix:
First Name:PIYADA
Middle Name:
Last Name:KUANKITPAISAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 SANDCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9691
Mailing Address - Country:US
Mailing Address - Phone:360-325-9837
Mailing Address - Fax:
Practice Address - Street 1:511 E MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4559
Practice Address - Country:US
Practice Address - Phone:360-650-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61192452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist