=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407732860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDY MYONG ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 917 SW OAK ST STE 301
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97205-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-975-2655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8242 NE EUGENE ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97220-5437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-975-2655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUDY DEHOOGH
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 503-975-2655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------