Healthcare Provider Details

I. General information

NPI: 1346371457
Provider Name (Legal Business Name): YAMAGUCHI HEALING ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 SE 182ND AVE
GRESHAM OR
97030
US

IV. Provider business mailing address

4322 SE 182ND AVE
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-8988
  • Fax: 503-667-8976
Mailing address:
  • Phone: 503-667-8988
  • Fax: 503-667-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00745
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LEAH R YAMAGUCHI
Title or Position: OWNER
Credential: LAC
Phone: 503-667-8988