Provider Demographics
NPI:1528477155
Name:TJ ACUPUNCTURE LLC
Entity type:Organization
Organization Name:TJ ACUPUNCTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAC.
Authorized Official - Prefix:
Authorized Official - First Name:TAIPING
Authorized Official - Middle Name:
Authorized Official - Last Name:JIA
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:503-475-9657
Mailing Address - Street 1:5677 BONITA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3217
Mailing Address - Country:US
Mailing Address - Phone:503-475-9657
Mailing Address - Fax:
Practice Address - Street 1:7110 SW FIR LOOP
Practice Address - Street 2:SUITE 205
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8084
Practice Address - Country:US
Practice Address - Phone:503-475-9657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty