Provider Demographics
NPI:1568761344
Name:YOUNG EAST ASIAN MEDICINE, LLC
Entity Type:Organization
Organization Name:YOUNG EAST ASIAN MEDICINE, LLC
Other - Org Name:WELLNESS AT THE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER YOUNG EAST ASIAN MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:LEIGH YOUNG
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-984-8301
Mailing Address - Street 1:11731 SE LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5935
Mailing Address - Country:US
Mailing Address - Phone:503-255-7000
Mailing Address - Fax:503-255-7001
Practice Address - Street 1:8931 SE FOSTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4661
Practice Address - Country:US
Practice Address - Phone:503-255-7000
Practice Address - Fax:503-255-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-20
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01277261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653508Medicaid