Provider Demographics
NPI:1194095976
Name:YIN YANG ACUPUNCTURE LLC
Entity type:Organization
Organization Name:YIN YANG ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KASUNIC
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM, LAC
Authorized Official - Phone:503-238-5920
Mailing Address - Street 1:206 SE 74TH AVE
Mailing Address - Street 2:APT B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1447
Mailing Address - Country:US
Mailing Address - Phone:503-238-5920
Mailing Address - Fax:
Practice Address - Street 1:2534 NW VAUGHN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2552
Practice Address - Country:US
Practice Address - Phone:503-238-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty