Healthcare Provider Details

I. General information

NPI: 1093915258
Provider Name (Legal Business Name): XIAO ZHOU L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 SW 110TH AVE
BEAVERTON OR
97005-3015
US

IV. Provider business mailing address

4220 SW 110TH AVE
BEAVERTON OR
97005-3015
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-7788
  • Fax:
Mailing address:
  • Phone: 503-646-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00245
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: