Provider Demographics
NPI:1386788537
Name:NORTHWEST FAMILY CARE CLINIC PLLC
Entity type:Organization
Organization Name:NORTHWEST FAMILY CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-413-8447
Mailing Address - Street 1:5203 LACEY BLVD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7236
Mailing Address - Country:US
Mailing Address - Phone:360-413-8447
Mailing Address - Fax:360-413-8493
Practice Address - Street 1:5203 LACEY BLVD SE
Practice Address - Street 2:SUITE A
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7236
Practice Address - Country:US
Practice Address - Phone:360-413-8447
Practice Address - Fax:360-413-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8298416Medicaid
WAAB28880Medicare ID - Type Unspecified
WA8298416Medicaid