Healthcare Provider Details

I. General information

NPI: 1619666278
Provider Name (Legal Business Name): LAVENDER GARDEN ACUPUNCTURE & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 LAKESIDE DR STE 5
SUNNYVALE CA
94085-4005
US

IV. Provider business mailing address

542 LAKESIDE DR STE 5
SUNNYVALE CA
94085-4005
US

V. Phone/Fax

Practice location:
  • Phone: 510-673-7789
  • 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: XIN CHEN
Title or Position: ACUPUNCTURIST
Credential:
Phone: 510-673-7789