MEDICARE: YUFANG XUE L.AC., DIPL.C.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00002853	WA
2	171100000X	Acupuncturist	AC00880	OR
3	171100000X	Acupuncturist	1235	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20576	OTHER		CHINESE HERBOLOGY

General Provider Information

NPI Number	:	1750493953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUFANG XUE L.AC., DIPL.C.H.

Provider Business Mailing Address
First Line	:	337 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2030
Country	:	US
Telephone Number	:	360-798-7132
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2030
Country	:	US
Telephone Number	:	360-798-7132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	12/18/2012

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