Healthcare Provider Details

I. General information

NPI: 1457682775
Provider Name (Legal Business Name): LEE E HULLENDER RUBIN DAOM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 NE CESAR E CHAVEZ BLVD
PORTLAND OR
97211-8125
US

IV. Provider business mailing address

PO BOX 11233
PORTLAND OR
97211-0233
US

V. Phone/Fax

Practice location:
  • Phone: 503-807-0158
  • Fax:
Mailing address:
  • Phone: 503-807-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1879
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18187
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC153822
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: