Provider Demographics
NPI:1497274922
Name:HAWTHORNE EAST ASIAN MEDICAL CLINIC
Entity Type:Organization
Organization Name:HAWTHORNE EAST ASIAN MEDICAL CLINIC
Other - Org Name:LAURELHURST FAMILY CLINIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-470-5200
Mailing Address - Street 1:2706 SE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5556
Mailing Address - Country:US
Mailing Address - Phone:503-928-2595
Mailing Address - Fax:
Practice Address - Street 1:4410 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2331
Practice Address - Country:US
Practice Address - Phone:503-470-5200
Practice Address - Fax:503-234-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC161513171100000X
ORAC153031171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty