Healthcare Provider Details

I. General information

NPI: 1275659245
Provider Name (Legal Business Name): YICAWELL ACUPUNCTURE AND HERBAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10311 S DE ANZA BLVD SUITE #4
CUPERTINO CA
95014-3028
US

IV. Provider business mailing address

10311 S DE ANZA BLVD SUITE #4
CUPERTINO CA
95014-3028
US

V. Phone/Fax

Practice location:
  • Phone: 408-252-1863
  • Fax:
Mailing address:
  • Phone: 408-252-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10293
License Number StateCA

VIII. Authorized Official

Name: MRS. YI SUN
Title or Position: PRESIDENT
Credential:
Phone: 408-242-4968