Healthcare Provider Details

I. General information

NPI: 1285820282
Provider Name (Legal Business Name): MARILYN LI-LIAN HUANG L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 NW FLANDERS ST SUITE 205
PORTLAND OR
97210-3442
US

IV. Provider business mailing address

2330 NW FLANDERS ST SUITE 101
PORTLAND OR
97210-3442
US

V. Phone/Fax

Practice location:
  • Phone: 503-701-8766
  • Fax: 503-241-5484
Mailing address:
  • Phone: 503-333-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01115
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: