Provider Demographics
NPI:1821217472
Name:LE, CHRISTINE HUONG THI (LAC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:HUONG THI
Last Name:LE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 SE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5225
Mailing Address - Country:US
Mailing Address - Phone:503-771-1345
Mailing Address - Fax:503-972-1849
Practice Address - Street 1:7636 SE FOSTER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5225
Practice Address - Country:US
Practice Address - Phone:503-771-1345
Practice Address - Fax:503-972-1849
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158757Medicaid
ORAC00384OtherLICENSED ACUPUNCTURIST