Healthcare Provider Details

I. General information

NPI: 1871283234
Provider Name (Legal Business Name): VI AU DACM, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E JACKSON ST
MEDFORD OR
97504-7073
US

IV. Provider business mailing address

1029 E JACKSON ST
MEDFORD OR
97504-7073
US

V. Phone/Fax

Practice location:
  • Phone: 541-532-1514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC230025
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: