Healthcare Provider Details

I. General information

NPI: 1629918925
Provider Name (Legal Business Name): PRIME WELLNESS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 S NORFOLK ST
SAN MATEO CA
94401-3536
US

IV. Provider business mailing address

3381 TRYNA DR
MOUNTAIN VIEW CA
94040-4548
US

V. Phone/Fax

Practice location:
  • Phone: 408-887-3068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HONGJUN LIU
Title or Position: CEO
Credential:
Phone: 408-887-3068