Healthcare Provider Details

I. General information

NPI: 1730691973
Provider Name (Legal Business Name): AGELESS ACUPUNCTURE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46923 WARM SPRINGS BLVD STE 206
FREMONT CA
94539-7977
US

IV. Provider business mailing address

46923 WARM SPRINGS BLVD STE 206
FREMONT CA
94539-7977
US

V. Phone/Fax

Practice location:
  • Phone: 510-556-5777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIANYING LIANG
Title or Position: ACUPUNCTURIST
Credential:
Phone: 415-666-6600