Healthcare Provider Details

I. General information

NPI: 1952906976
Provider Name (Legal Business Name): YICAWELL ACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N PARK VICTORIA DR STE F
MILPITAS CA
95035-4600
US

IV. Provider business mailing address

42271 BLACOW RD
FREMONT CA
94538-4172
US

V. Phone/Fax

Practice location:
  • Phone: 408-252-1863
  • Fax:
Mailing address:
  • Phone: 408-242-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YI SUN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 408-242-4968