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General NPI Number Information
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NPI Number | 1184054116
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Entity Type | Organization
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Legal Business Name | FOREVER YANG LLC
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 19273 MOLALLA AVE SUITE F
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City | OREGON CITY
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State | OR
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Zip | 97045-8053
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Country | US
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Telephone | 971-338-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 19273 MOLALLA AVE SUITE F
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City | OREGON CITY
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State | OR
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Zip | 97045-8053
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Country | US
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Telephone | 971-338-9355
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MELISSA BROWN
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Credential | LAC
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Telephone | 503-764-7375
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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 | AC165264
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC160277
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License Number State | OR
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