Healthcare Provider Details

I. General information

NPI: 1720562655
Provider Name (Legal Business Name): MERIDIAN ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 UNIVERSITY DR STE 204
MENLO PARK CA
94025-4265
US

IV. Provider business mailing address

849 WINTERGREEN WAY
PALO ALTO CA
94303-4109
US

V. Phone/Fax

Practice location:
  • Phone: 650-380-9996
  • 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LI-REN DELVAUX WEN
Title or Position: MANAGER
Credential:
Phone: 650-380-9996