Healthcare Provider Details

I. General information

NPI: 1356278006
Provider Name (Legal Business Name): PING AN WELLNESS CLINICINC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 S DE ANZA BLVD # A109
SAN JOSE CA
95129-3500
US

IV. Provider business mailing address

1072 S DE ANZA BLVD # A109
SAN JOSE CA
95129-3500
US

V. Phone/Fax

Practice location:
  • Phone: 408-213-2928
  • Fax:
Mailing address:
  • Phone: 408-213-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TREVOR L HUNTLEY
Title or Position: ACUPUNCTURIST
Credential: LAC.
Phone: 408-213-2926