Provider Demographics
NPI:1649463027
Name:ACUPUNCTURE & HERBAL MEDICINE CLINIC
Entity type:Organization
Organization Name:ACUPUNCTURE & HERBAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:425-643-3758
Mailing Address - Street 1:1 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2417
Mailing Address - Country:US
Mailing Address - Phone:425-643-3758
Mailing Address - Fax:
Practice Address - Street 1:1 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:425-643-3758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000342171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC00000342OtherOWNERS LAC LICENSE
WAAC00000342OtherOWNERS LAC LICENSE