Healthcare Provider Details

I. General information

NPI: 1871981050
Provider Name (Legal Business Name): METTA GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ASHBY AVE
BERKELEY CA
94705-2200
US

IV. Provider business mailing address

1739 DWIGHT WAY
BERKELEY CA
94703-1963
US

V. Phone/Fax

Practice location:
  • Phone: 510-207-7162
  • Fax:
Mailing address:
  • Phone: 510-207-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15161
License Number StateCA

VIII. Authorized Official

Name: MR. LOC T HUYNH
Title or Position: ACUPUNCTURIST
Credential: L.AC.
Phone: 510-207-7162