Provider Demographics
NPI:1235685595
Name:TIAN LONG ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:TIAN LONG ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:EBALO
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP
Authorized Official - Phone:206-898-1204
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-1221
Mailing Address - Country:US
Mailing Address - Phone:206-898-1204
Mailing Address - Fax:
Practice Address - Street 1:1611 116TH AVE NE
Practice Address - Street 2:SUITE 121
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3064
Practice Address - Country:US
Practice Address - Phone:206-898-1204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002441171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty