Provider Demographics
NPI:1992711717
Name:KASIOLARN, TEERAWONG (ND, MSA, LAC)
Entity type:Individual
Prefix:DR
First Name:TEERAWONG
Middle Name:
Last Name:KASIOLARN
Suffix:
Gender:M
Credentials:ND, MSA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 K ST NW STE 900
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-5349
Mailing Address - Country:US
Mailing Address - Phone:571-207-6768
Mailing Address - Fax:202-831-3132
Practice Address - Street 1:1717 K ST NW STE 900
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-5349
Practice Address - Country:US
Practice Address - Phone:571-207-6768
Practice Address - Fax:202-831-3132
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000439171100000X
VT099-0000244175F00000X
DCNP-0041175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNP-0041OtherNATUROPATHIC PHYSICIAN
VT099-0000244OtherNATUROPATHIC LICENSURE