Healthcare Provider Details

I. General information

NPI: 1710733100
Provider Name (Legal Business Name): MAHJONG ACUPUNCTURE AND TRADITIONAL CHINESE MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4546 EL CAMINO REAL STE B6
LOS ALTOS CA
94022-1069
US

IV. Provider business mailing address

4546 EL CAMINO REAL STE B6
LOS ALTOS CA
94022-1069
US

V. Phone/Fax

Practice location:
  • Phone: 650-949-3637
  • Fax: 650-942-0272
Mailing address:
  • Phone: 650-949-3637
  • Fax: 650-942-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KEVIN TAI
Title or Position: PRESIDENT AND CEO
Credential: DAOM, LAC
Phone: 650-949-3637