Healthcare Provider Details

I. General information

NPI: 1639367899
Provider Name (Legal Business Name): HAI SHAN CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39420 SE GORDON CREEK RD
CORBETT OR
97019-8750
US

IV. Provider business mailing address

PO BOX 402
CORBETT OR
97019-0402
US

V. Phone/Fax

Practice location:
  • Phone: 503-695-2977
  • Fax: 503-695-2968
Mailing address:
  • Phone: 503-695-2977
  • Fax: 503-695-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00299
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1499
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0915
License Number StateOR

VIII. Authorized Official

Name: DR. HEINRICH O FREUHAUF
Title or Position: PRESIDENT
Credential: PHD, LAC
Phone: 503-695-2977