Provider Demographics
NPI:1114250008
Name:SHIRAI, KUMIKO (LAC)
Entity Type:Individual
Prefix:MS
First Name:KUMIKO
Middle Name:
Last Name:SHIRAI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 SE 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2034
Mailing Address - Country:US
Mailing Address - Phone:503-841-5781
Mailing Address - Fax:503-227-1089
Practice Address - Street 1:3024 SE 59TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2034
Practice Address - Country:US
Practice Address - Phone:503-841-5781
Practice Address - Fax:503-227-1089
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC 01219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist