Healthcare Provider Details

I. General information

NPI: 1851574487
Provider Name (Legal Business Name): EVERGREEN BIO-TECH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N ORACLE RD SUITE 145
TUCSON AZ
85704-3829
US

IV. Provider business mailing address

9221 E BASELINE RD SUITE A109-617
MESA AZ
85209-8310
US

V. Phone/Fax

Practice location:
  • Phone: 520-889-9366
  • Fax: 480-357-4639
Mailing address:
  • Phone: 480-357-3904
  • Fax: 480-357-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0448
License Number StateAZ

VIII. Authorized Official

Name: TENG FANG WU
Title or Position: PROVIDER
Credential: DOCTOR ORIENTAL MED
Phone: 480-357-3904