=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457519035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING SAGE ACUPUNCTURE AND HERBAL CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2008
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 337 NE 5TH AVE
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-798-7132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 337 NE 5TH AVE
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. YUFANG XUE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-798-7132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC00002853
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------