Provider Demographics
NPI:1184176968
Name:BHAGWANDIN, KHAIRUL (AC60901366)
Entity type:Individual
Prefix:
First Name:KHAIRUL
Middle Name:
Last Name:BHAGWANDIN
Suffix:
Gender:F
Credentials:AC60901366
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 LEARY AVE NW
Mailing Address - Street 2:STE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107
Mailing Address - Country:US
Mailing Address - Phone:206-582-3471
Mailing Address - Fax:206-582-3472
Practice Address - Street 1:5401 LEARY AVE NW
Practice Address - Street 2:STE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:206-582-3471
Practice Address - Fax:206-582-3472
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2022-05-17
Deactivation Date:2022-03-16
Deactivation Code:
Reactivation Date:2022-05-04
Provider Licenses
StateLicense IDTaxonomies
WAAC60901366171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist