Healthcare Provider Details

I. General information

NPI: 1679646152
Provider Name (Legal Business Name): G & L INTERNATIONAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 SW BEAVERTON HILLSDALE HWY
BEAVERTON OR
97005-3309
US

IV. Provider business mailing address

9520 SW BEAVERTON HILLSDALE HWY
BEAVERTON OR
97005-3309
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-1788
  • Fax: 503-643-4699
Mailing address:
  • Phone: 503-643-1788
  • Fax: 503-643-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ZHENG GONG
Title or Position: BUSINESS OWNER
Credential: L.AC.
Phone: 503-643-1788