Individual
MRS. KANYAKANIT BUPPAWONG DEPAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
14850 LAKE HILLS BLVD, # 4, BELLEVUE, WA 98007-5800
(425) 558-9441
Mailing address
308 146TH PL NE, BELLEVUE, WA 98007-4941
(206) 235-5557
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA 00024931
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA 00024931
LMP
WA
Enumeration date
07/08/2011
Last updated
07/08/2011
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