Healthcare Provider Details

I. General information

NPI: 1821714957
Provider Name (Legal Business Name): JL ACUPUNCTURE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 D ST STE D
SAN RAFAEL CA
94901-3765
US

IV. Provider business mailing address

136 ROUNDTREE BLVD
SAN RAFAEL CA
94903-1646
US

V. Phone/Fax

Practice location:
  • Phone: 415-258-0388
  • Fax:
Mailing address:
  • Phone: 415-258-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JINFENG LI
Title or Position: CEO
Credential:
Phone: 415-258-0388