Provider Demographics
NPI:1730683442
Name:RED PINE TCM, LLC
Entity type:Organization
Organization Name:RED PINE TCM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF RED PINE TCM, LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:BOEY
Authorized Official - Middle Name:YEAN
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM
Authorized Official - Phone:503-209-9802
Mailing Address - Street 1:5103 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4107
Mailing Address - Country:US
Mailing Address - Phone:503-209-9802
Mailing Address - Fax:
Practice Address - Street 1:4016 SE 31ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3404
Practice Address - Country:US
Practice Address - Phone:503-209-9802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC170153171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty