Individual
DAVINA XAYSANASONGKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
10615 SE 250TH PL, C101, KENT, WA 98030-6497
(206) 423-5776
Mailing address
10615 SE 250TH PL, C101, KENT, WA 98030-6497
(206) 423-5776
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
MA60303913
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA60303913
MASSAGE LICENSE NUMBER
WA
Enumeration date
03/17/2013
Last updated
03/17/2013
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