Healthcare Provider Details

I. General information

NPI: 1972279438
Provider Name (Legal Business Name): LAKE HILLS ACUPUNCTURE & ORIENTAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 156TH AVE NE STE 5
BELLEVUE WA
98007-4344
US

IV. Provider business mailing address

1811 156TH AVE NE STE 5
BELLEVUE WA
98007-4344
US

V. Phone/Fax

Practice location:
  • Phone: 425-372-7248
  • Fax: 888-508-8115
Mailing address:
  • Phone: 425-372-7248
  • Fax: 888-508-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: TONG NING
Title or Position: OWNER
Credential:
Phone: 425-372-7248