Provider Demographics
NPI:1073302204
Name:WESTLAKE INTEGRATIVE MEDICINE LLC
Entity type:Organization
Organization Name:WESTLAKE INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:YUTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-479-5608
Mailing Address - Street 1:14110 GABRIELLE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5759
Mailing Address - Country:US
Mailing Address - Phone:503-314-7889
Mailing Address - Fax:
Practice Address - Street 1:14535 WESTLAKE DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7775
Practice Address - Country:US
Practice Address - Phone:503-479-5608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114963196OtherTYPE 1 NPI