Healthcare Provider Details

I. General information

NPI: 1194228858
Provider Name (Legal Business Name): B T K A USA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 MORNINGSIDE WAY
VENICE CA
90291-2932
US

IV. Provider business mailing address

1252 MORNINGSIDE WAY
VENICE CA
90291-2932
US

V. Phone/Fax

Practice location:
  • Phone: 310-396-8581
  • Fax: 310-804-5036
Mailing address:
  • Phone: 310-396-8581
  • Fax: 310-804-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10573
License Number StateCA

VIII. Authorized Official

Name: WEIXHANG WANG
Title or Position: PRESIDENT / CEO
Credential:
Phone: 626-300-0885