Little Wing Acupuncture

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC156429 Issued in OR

Legal business name

LITTLE WING ACUPUNCTURE

Practice address

833 SW 11TH Ave
Suite #1018
Portland, OR 97205-2125

Phone

(503) 224-2525

Fax

(503) 224-3397

NPI assigned

Jun 12, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevi Keenom, LAC, MACOM

Title

Owner, Practitioner

Phone

(503) 224-2525

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1275947723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE #1018",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "503-224-2525",
            "fax_number": "503-224-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE #1018",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "503-224-2525",
            "fax_number": "503-224-3397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE WING ACUPUNCTURE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-12",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "KEENOM",
        "authorized_official_first_name": "KEVI",
        "authorized_official_title_or_position": "OWNER, PRACTITIONER",
        "authorized_official_telephone_number": "503-224-2525",
        "authorized_official_credential": "LAC, MACOM"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC156429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.