MEDICARE: DR. VIRGINIA MA DAIM, L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	2108	MN

General Provider Information

NPI Number	:	1316735590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA MA DAIM, L.AC.

Provider Business Mailing Address
First Line	:	2112 BROADWAY ST NE STE 250
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-3082
Country	:	US
Telephone Number	:	612-339-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 BROADWAY ST NE STE 250
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-3082
Country	:	US
Telephone Number	:	612-339-5088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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