Provider Demographics
NPI:1225445166
Name:NORTHWEST ACUPUNCTURE
Entity Type:Organization
Organization Name:NORTHWEST ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IN
Authorized Official - Middle Name:HYONGYU
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:503-297-1174
Mailing Address - Street 1:10224 SW PARK WAY # A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5010
Mailing Address - Country:US
Mailing Address - Phone:503-297-1174
Mailing Address - Fax:503-297-2623
Practice Address - Street 1:10224 SW PARK WAY # A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5010
Practice Address - Country:US
Practice Address - Phone:503-297-1174
Practice Address - Fax:503-297-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01149305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization