Healthcare Provider Details

I. General information

NPI: 1518521038
Provider Name (Legal Business Name): TCM ACUPUNCTURE AND MASSAGE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 WESTLAKE DR STE B
LAKE OSWEGO OR
97035-7775
US

IV. Provider business mailing address

14535 WESTLAKE DR STE B
LAKE OSWEGO OR
97035-7775
US

V. Phone/Fax

Practice location:
  • Phone: 503-347-4286
  • Fax: 971-713-3940
Mailing address:
  • Phone: 503-347-4286
  • Fax: 971-713-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LI HONG CHEN
Title or Position: ACUPUNCTURIST/OWNER
Credential: LAC.
Phone: 503-347-4286