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General NPI Number Information
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NPI Number | 1437857729
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Entity Type | Organization
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Legal Business Name | EAST WEST DPC
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 1524 W CAYUSE CREEK DR
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City | MERIDIAN
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State | ID
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Zip | 83646-4795
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Country | US
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Telephone | 208-509-8987
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Fax |
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Provider Business Mailing Address
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Address Line | 141 N PALMETTO AVE UNIT 602
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City | EAGLE
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State | ID
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Zip | 83616-8025
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Country | US
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Telephone | 208-509-8987
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LOUISE YE-LIEW
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Credential | DO
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Telephone | 208-509-8987
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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