Provider Demographics
NPI:1194442400
Name:SAIWONGPANYA, KANOKWAN
Entity type:Individual
Prefix:
First Name:KANOKWAN
Middle Name:
Last Name:SAIWONGPANYA
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:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0463
Mailing Address - Country:US
Mailing Address - Phone:425-329-5372
Mailing Address - Fax:
Practice Address - Street 1:1453 BELLEVUE WAY NE APT D
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8212
Practice Address - Country:US
Practice Address - Phone:425-329-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60292535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist