Healthcare Provider Details

I. General information

NPI: 1083172464
Provider Name (Legal Business Name): PRISTINE ORIENTAL ACUPUNCTURE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39825 PASEO PADRE PKWY STE B
FREMONT CA
94538-3031
US

IV. Provider business mailing address

39825 PASEO PADRE PKWY STE B
FREMONT CA
94538-3031
US

V. Phone/Fax

Practice location:
  • Phone: 510-256-9870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CHAI
Title or Position: MANAGER
Credential:
Phone: 510-256-9870