Provider Demographics
NPI:1174940258
Name:ACULINKS ACUPUNCTURE, INC.
Entity type:Organization
Organization Name:ACULINKS ACUPUNCTURE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-473-3613
Mailing Address - Street 1:5809 SE 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-4823
Mailing Address - Country:US
Mailing Address - Phone:503-473-3613
Mailing Address - Fax:503-972-1849
Practice Address - Street 1:7636 SE FOSTER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5225
Practice Address - Country:US
Practice Address - Phone:503-473-3613
Practice Address - Fax:503-972-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653609Medicaid