Healthcare Provider Details

I. General information

NPI: 1629460936
Provider Name (Legal Business Name): WYLIE HUEY ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 PARK BLVD
OAKLAND CA
94606-1405
US

IV. Provider business mailing address

2345 PARK BLVD
OAKLAND CA
94606-1405
US

V. Phone/Fax

Practice location:
  • Phone: 510-698-9037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15301
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16255
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14803
License Number StateCA

VIII. Authorized Official

Name: WYLIE HUEY
Title or Position: PRESIDENT
Credential: L.AC.
Phone: 510-698-9037