Healthcare Provider Details

I. General information

NPI: 1053044032
Provider Name (Legal Business Name): SHAO LUN HO LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 SW WASHINGTON AVE
BEAVERTON OR
97005-0530
US

IV. Provider business mailing address

4670 SW WASHINGTON AVE
BEAVERTON OR
97005-0530
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-8575
  • Fax:
Mailing address:
  • Phone: 971-777-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC211606
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: