Healthcare Provider Details

I. General information

NPI: 1518233170
Provider Name (Legal Business Name): YIBIN HUANG, L.AC. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 NE GLISAN ST
PORTLAND OR
97220-2228
US

IV. Provider business mailing address

11111 NE GLISAN ST
PORTLAND OR
97220-2228
US

V. Phone/Fax

Practice location:
  • Phone: 503-317-9326
  • Fax: 503-564-4650
Mailing address:
  • Phone: 503-317-9326
  • Fax: 503-564-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00463
License Number StateOR

VIII. Authorized Official

Name: MR. YIBIN HUANG
Title or Position: LICENSED ACUPUNCTRIST
Credential: L.AC.
Phone: 503-317-9326