Healthcare Provider Details

I. General information

NPI: 1053451120
Provider Name (Legal Business Name): TAO ZHOU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11719 NE 95TH ST STE F
VANCOUVER WA
98682-2444
US

IV. Provider business mailing address

3700 SE 183RD CT
VANCOUVER WA
98683
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-3188
  • Fax:
Mailing address:
  • Phone: 360-882-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002291
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: