Provider Demographics
NPI:1316085509
Name:BOONCHAI CORPORATION
Entity type:Organization
Organization Name:BOONCHAI CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:BOONCHAI
Authorized Official - Last Name:APICHAI
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP
Authorized Official - Phone:206-289-0303
Mailing Address - Street 1:11345 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6858
Mailing Address - Country:US
Mailing Address - Phone:206-289-0303
Mailing Address - Fax:
Practice Address - Street 1:12025 LAKE CITY WAY NE STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5331
Practice Address - Country:US
Practice Address - Phone:206-289-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty