Individual
AJA NGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC.
Contact information
Practice address
5319 SW WESTGATE DR, #148, PORTLAND, OR 97221-2411
(503) 928-9916
(503) 383-9105
Mailing address
5319 SW WESTGATE DR, #148, PORTLAND, OR 97221-2411
(503) 928-9916
(503) 383-9105
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01105
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC01105
BME ACUPUNCTURE LICENSE
OR
01
—
U01077
ACUPUNCTURE LICENSE
MD
Enumeration date
06/29/2007
Last updated
07/08/2007
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