Healthcare Provider Details

I. General information

NPI: 1073026183
Provider Name (Legal Business Name): DAO WELLNESS & ACUPUNCTURE CENTER, A PROF. ORG.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 MERIDIAN AVE STE 30
SAN JOSE CA
95120-2700
US

IV. Provider business mailing address

6055 MERIDIAN AVE STE 30
SAN JOSE CA
95120-2700
US

V. Phone/Fax

Practice location:
  • Phone: 408-766-1811
  • Fax: 408-550-7112
Mailing address:
  • Phone: 408-766-1811
  • Fax: 408-550-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number54384
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberA16628
License Number StateCA

VIII. Authorized Official

Name: MR. BRYAN J REISINGER
Title or Position: CEO / CHIEF ACUPUNCTURIST
Credential: L.AC., CMT, MTCM
Phone: 408-766-1811