Provider Demographics
NPI:1679258834
Name:DR KAN WELLNESS CENTER LLC
Entity type:Organization
Organization Name:DR KAN WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TEERAWONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KASIOLARN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:571-207-6768
Mailing Address - Street 1:186 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3847
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service