Healthcare Provider Details

I. General information

NPI: 1740673607
Provider Name (Legal Business Name): WENLI ZHU L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
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: 971-533-0374
  • Fax:
Mailing address:
  • Phone: 971-533-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC170404
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: