Healthcare Provider Details

I. General information

NPI: 1164791224
Provider Name (Legal Business Name): TSUEYHWA LAI DAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38530 PLEASANT ST
SANDY OR
97055-6395
US

IV. Provider business mailing address

38530 PLEASANT ST
SANDY OR
97055-6395
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-7631
  • Fax: 971-231-1503
Mailing address:
  • Phone: 503-668-7631
  • Fax: 971-231-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC000773
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: