Provider Demographics
NPI:1104112028
Name:METHACHITTIPHAN, NILUBON
Entity type:Individual
Prefix:
First Name:NILUBON
Middle Name:
Last Name:METHACHITTIPHAN
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 1:1959 NE PACIFIC ST STE BB552
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-685-1397
Mailing Address - Fax:206-685-9394
Practice Address - Street 1:1959 NE PACIFIC ST STE BB552
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0553
Practice Address - Country:US
Practice Address - Phone:206-685-1397
Practice Address - Fax:206-685-9394
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248059207R00000X
TXBP10049193207RC0000X
WAMD60733931207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease