Provider Demographics
NPI:1770638389
Name:INTEGRATED ORIENTAL MEDICINE, PS
Entity Type:Organization
Organization Name:INTEGRATED ORIENTAL MEDICINE, PS
Other - Org Name:DR MEN ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEIJING
Authorized Official - Middle Name:
Authorized Official - Last Name:MEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:206-440-1634
Mailing Address - Street 1:10212 5TH AVE NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7452
Mailing Address - Country:US
Mailing Address - Phone:206-440-1634
Mailing Address - Fax:206-374-8202
Practice Address - Street 1:12715 BEL RED RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2627
Practice Address - Country:US
Practice Address - Phone:206-440-1634
Practice Address - Fax:206-374-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602675883261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service