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General NPI Number Information
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NPI Number | 1104076173
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Entity Type | Organization
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Legal Business Name | KATHLEEN E KING LLC
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 1111 SW 10TH AVE
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City | PORTLAND
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State | OR
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Zip | 97205-2411
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Country | US
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Telephone | 503-294-7420
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Fax | 503-294-7411
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Provider Business Mailing Address
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Address Line | 1111 SW 10TH AVE
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City | PORTLAND
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State | OR
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Zip | 97205-2411
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Country | US
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Telephone | 503-294-7420
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Fax | 503-294-7411
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | KATHLEEN ELIZABETH KING
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Credential | LAC
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Telephone | 971-222-6370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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