Provider Demographics
NPI:1790082428
Name:PREMIER ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:PREMIER ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:YOUNG JOON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, EAMP, MACOM
Authorized Official - Phone:360-892-4355
Mailing Address - Street 1:6405 NE 116TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2401
Mailing Address - Country:US
Mailing Address - Phone:360-892-4355
Mailing Address - Fax:
Practice Address - Street 1:6405 NE 116TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-2401
Practice Address - Country:US
Practice Address - Phone:360-892-4355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60197003171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty