Provider Demographics
NPI:1811776222
Name:PRIME ACUPUNCTURE AND HERBOLOGY, LLC
Entity type:Organization
Organization Name:PRIME ACUPUNCTURE AND HERBOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:JI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:715-497-4778
Mailing Address - Street 1:2305 SE WASHINGTON ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7647
Mailing Address - Country:US
Mailing Address - Phone:559-745-5030
Mailing Address - Fax:
Practice Address - Street 1:2305 SE WASHINGTON ST STE 110
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7647
Practice Address - Country:US
Practice Address - Phone:559-745-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty