Provider Demographics
NPI:1790097772
Name:DR. LU'S ACUPUNTURE & MASSAGE CLINIC, LLC
Entity Type:Organization
Organization Name:DR. LU'S ACUPUNTURE & MASSAGE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC DAOM
Authorized Official - Phone:503-317-3113
Mailing Address - Street 1:12778 SE STARK ST.
Mailing Address - Street 2:BLAZA 125, BLDG B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233
Mailing Address - Country:US
Mailing Address - Phone:503-317-3113
Mailing Address - Fax:503-459-4709
Practice Address - Street 1:12778 SE STARK ST.
Practice Address - Street 2:BLAZA 125, BLDG B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-317-3113
Practice Address - Fax:503-459-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00498171100000X
WAAC00002588171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty