Provider Demographics
NPI:1407332539
Name:HAONG, BENJAMIN MINLEE (LMT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MINLEE
Last Name:HAONG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 KOTKA ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-4339
Mailing Address - Country:US
Mailing Address - Phone:206-356-5337
Mailing Address - Fax:
Practice Address - Street 1:1208 KOTKA ST
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-4339
Practice Address - Country:US
Practice Address - Phone:206-356-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24490225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist