MEDICARE: NOURISHING LIFE NATURAL MEDICINE

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
2	175F00000X	Naturopath

General Provider Information

NPI Number	:	1750224937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHING LIFE NATURAL MEDICINE

Provider Business Mailing Address
First Line	:	6226 NE 9TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3767
Country	:	US
Telephone Number	:	503-781-2682
Fax Number	:

Provider Business Practice Location Address
First Line	:	6226 NE 9TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3767
Country	:	US
Telephone Number	:	503-781-2682
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HYEYEON KIM
Credential	:	ND, LAC
Telephone Number	:	503-781-2682

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “NOURISHING LIFE NATURAL MEDICINE ” Practice Location

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