Provider Demographics
NPI:1194107847
Name:LOTUS ACUPUNCTURE & FERTILITY CLINIC
Entity type:Organization
Organization Name:LOTUS ACUPUNCTURE & FERTILITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHENBO
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:360-798-4950
Mailing Address - Street 1:501 SE 123RD AVE APT N100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4041
Mailing Address - Country:US
Mailing Address - Phone:360-798-4950
Mailing Address - Fax:360-896-0424
Practice Address - Street 1:15593 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8954
Practice Address - Country:US
Practice Address - Phone:360-798-4950
Practice Address - Fax:360-896-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002855305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization