Provider Demographics
NPI:1487710430
Name:POOPHAWATANAKIK, KAMPOL (LAC)
Entity type:Individual
Prefix:
First Name:KAMPOL
Middle Name:
Last Name:POOPHAWATANAKIK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S PINE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2795
Mailing Address - Country:US
Mailing Address - Phone:253-396-1000
Mailing Address - Fax:253-396-1012
Practice Address - Street 1:601 S PINE ST STE 201
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2795
Practice Address - Country:US
Practice Address - Phone:253-396-1000
Practice Address - Fax:253-396-1012
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002685171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist