Healthcare Provider Details

I. General information

NPI: 1881109361
Provider Name (Legal Business Name): ADVANCED ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9411 NE HIGHWAY 99 STE 1
VANCOUVER WA
98665-8970
US

IV. Provider business mailing address

9411 NE HIGHWAY 99 SUITE 1
VANCOUVER WA
98665-8970
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-8515
  • Fax: 360-571-8516
Mailing address:
  • Phone: 360-571-8515
  • Fax: 360-571-8516

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
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAC00000606
License Number StateWA

VIII. Authorized Official

Name: DR. NOOSHIN NIKKI MEDGHALCHY
Title or Position: OWNER
Credential: DAOM, L.AC.
Phone: 360-571-8515