Provider Demographics
NPI:1225165194
Name:MONTAGE, SANG LY (LAC)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:LY
Last Name:MONTAGE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:SANG
Other - Middle Name:LY
Other - Last Name:MONTAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:3833 HUMBUG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:APPLEGATE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9620
Mailing Address - Country:US
Mailing Address - Phone:541-231-6558
Mailing Address - Fax:
Practice Address - Street 1:15095 HIGHWAY 238
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9612
Practice Address - Country:US
Practice Address - Phone:541-231-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC 01047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist