Provider Demographics
NPI:1861942914
Name:LILY ACUPUNCTURE HEALING SPACE
Entity type:Organization
Organization Name:LILY ACUPUNCTURE HEALING SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORE OF ACUPUNCTURE AND OM
Authorized Official - Prefix:
Authorized Official - First Name:MIN-HWA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:360-718-7897
Mailing Address - Street 1:1912 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4603
Mailing Address - Country:US
Mailing Address - Phone:360-718-7897
Mailing Address - Fax:
Practice Address - Street 1:1912 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4603
Practice Address - Country:US
Practice Address - Phone:360-718-7897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60651194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty