MEDICARE: HEALING SAGE ACUPUNCTURE AND HERBAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00002853	WA

General Provider Information

NPI Number	:	1457519035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING SAGE ACUPUNCTURE AND HERBAL CLINIC

Provider Business Mailing Address
First Line	:	337 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2030
Country	:	US
Telephone Number	:	360-798-7132
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. YUFANG XUE
Credential	:
Telephone Number	:	360-798-7132

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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