Provider Demographics
NPI:1811622236
Name:MIMI ASIAN MASSAGE & SPA
Entity type:Organization
Organization Name:MIMI ASIAN MASSAGE & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LANYING
Authorized Official - Middle Name:
Authorized Official - Last Name:HOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-781-1360
Mailing Address - Street 1:16835 S CLIFF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9412
Mailing Address - Country:US
Mailing Address - Phone:503-781-1360
Mailing Address - Fax:
Practice Address - Street 1:14981 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7612
Practice Address - Country:US
Practice Address - Phone:503-985-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty