Healthcare Provider Details

I. General information

NPI: 1932181492
Provider Name (Legal Business Name): LILI ZHENG DAOM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12778 SE STARK ST
PORTLAND OR
97233-1539
US

IV. Provider business mailing address

12778 SE STARK ST
PORTLAND OR
97233-1539
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-5684
  • Fax:
Mailing address:
  • Phone: 503-253-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00670
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: