Provider Demographics
NPI:1679845234
Name:CAI, LING CHUN (L M T)
Entity Type:Individual
Prefix:
First Name:LING
Middle Name:CHUN
Last Name:CAI
Suffix:
Gender:F
Credentials:L M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SW YAMHILL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2538
Mailing Address - Country:US
Mailing Address - Phone:503-329-7222
Mailing Address - Fax:
Practice Address - Street 1:2318 NW SCHMIDT WAY APT 39
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4772
Practice Address - Country:US
Practice Address - Phone:503-329-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist