Basic Information
| Provider Information | |||||||||
| NPI: | 1083159701 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANCIENT ASIA ACUPUNCTURE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1607 LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950503983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082611777 | ||||||||
| FaxNumber: | 4082611111 | ||||||||
| Practice Location | |||||||||
| Address1: | 1607 LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950503983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082611777 | ||||||||
| FaxNumber: | 4082611111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2017 | ||||||||
| LastUpdateDate: | 01/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | YANG | ||||||||
| AuthorizedOfficialFirstName: | LIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | O.M.D | ||||||||
| AuthorizedOfficialTelephone: | 4082611777 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC6620 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.