Provider Demographics
NPI:1457519035
Name:HEALING SAGE ACUPUNCTURE AND HERBAL CLINIC
Entity Type:Organization
Organization Name:HEALING SAGE ACUPUNCTURE AND HERBAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUFANG
Authorized Official - Middle Name:
Authorized Official - Last Name:XUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-798-7132
Mailing Address - Street 1:337 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:337 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2030
Practice Address - Country:US
Practice Address - Phone:360-798-7132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002853171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty