Provider Demographics
NPI:1316744303
Name:MALMSTADT, CHOTIKA THONGNUEPAD (LAC)
Entity type:Individual
Prefix:
First Name:CHOTIKA
Middle Name:THONGNUEPAD
Last Name:MALMSTADT
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 NE HIGHWAY 99 STE 1
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8970
Mailing Address - Country:US
Mailing Address - Phone:360-571-8515
Mailing Address - Fax:
Practice Address - Street 1:9411 NE HIGHWAY 99 STE 1
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8970
Practice Address - Country:US
Practice Address - Phone:360-571-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC218538171100000X
WAAC61553757171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist