Healthcare Provider Details

I. General information

NPI: 1326479858
Provider Name (Legal Business Name): EUDEMONIA MEDICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MCCARTHY BLVD #115
MILPITAS CA
95035
US

IV. Provider business mailing address

1851 MCCARTHY BLVD STE 115
MILPITAS CA
95035-7448
US

V. Phone/Fax

Practice location:
  • Phone: 408-641-1004
  • Fax:
Mailing address:
  • Phone: 408-641-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D2040223
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JAE K WI
Title or Position: PRESIDENT
Credential: M.D., PH.D.
Phone: 408-641-1004