Active NPI
Kanyakanit Buppawong Depaz, LMP
- Mechanotherapist
- Bellevue, WA
National Provider Identifier
1093002172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- MA 00024931
- Practice address
- 14850 Lake Hills Blvd
# 4
Bellevue, WA 98007-5800 - Phone
- (425) 558-9441
- NPI assigned
- Jul 8, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | MA 00024931 | WA | Primary |
Addresses
Primary practice location
14850 Lake Hills Blvd
# 4
Bellevue, WA 98007-5800
Mailing address
308 146TH PL NE
Bellevue, WA 98007-4941
Phone (206) 235-5557
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA 00024931 | Other | WA | LMP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 00024931 | WA | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310083200000",
"number": "1093002172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 146TH PL NE",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980074941",
"telephone_number": "206-235-5557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14850 LAKE HILLS BLVD",
"address_2": "# 4",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980075800",
"telephone_number": "425-558-9441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEPAZ",
"first_name": "KANYAKANIT",
"middle_name": "BUPPAWONG",
"name_prefix": "Mrs.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-08",
"last_updated": "2011-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "WA",
"license": "MA 00024931",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMP",
"identifier": "MA 00024931",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.