MEDICARE: MING ACUPUNCTURE AND HERB CENTER,P.C.

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	305R00000X	Preferred Provider Organization	AC 16696	CA

General Provider Information

NPI Number	:	1356891642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MING ACUPUNCTURE AND HERB CENTER,P.C.

Provider Business Mailing Address
First Line	:	809 SAN ANTONIO RD
Second Line	:	#10
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4634
Country	:	US
Telephone Number	:	650-320-9538
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 SAN ANTONIO RD
Second Line	:	#10
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4634
Country	:	US
Telephone Number	:	650-320-9538
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JERRY YOURUI WU
Credential	:	L.AC.
Telephone Number	:	650-320-9538

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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