Provider Demographics
NPI: | 1528226412 |
---|---|
Name: | ACUHERBAL HEALTH LLC |
Entity Type: | Organization |
Organization Name: | ACUHERBAL HEALTH LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | YUQING |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KOU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LAC |
Authorized Official - Phone: | 503-261-9603 |
Mailing Address - Street 1: | 725 NE 102ND AVE |
Mailing Address - Street 2: | STE A |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97220 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-261-9603 |
Mailing Address - Fax: | 503-261-9600 |
Practice Address - Street 1: | 725 NE 102ND AVE |
Practice Address - Street 2: | STE A |
Practice Address - City: | PORTLAND |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97220 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-261-9603 |
Practice Address - Fax: | 503-261-9600 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-05-28 |
Last Update Date: | 2017-03-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | AC00936 | 171100000X |
OR | AC174535 | 171100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty |