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General NPI Number Information
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NPI Number | 1194107847
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Entity Type | Organization
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Legal Business Name | LOTUS ACUPUNCTURE & FERTILITY CLINIC
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 15593 SE MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98684-8954
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Country | US
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Telephone | 360-798-4950
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Fax | 360-896-0424
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Provider Business Mailing Address
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Address Line | 501 SE 123RD AVE APT N100
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City | VANCOUVER
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State | WA
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Zip | 98683-4041
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Country | US
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Telephone | 360-798-4950
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Fax | 360-896-0424
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Authorized Official
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Title or Position | OWNER
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Name | DR. ZHENBO LI
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Credential | LAC
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Telephone | 360-798-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | AC00002855
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License Number State | WA
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