Healthcare Provider Details

I. General information

NPI: 1376998518
Provider Name (Legal Business Name): CHINN QIGONG & ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LA CASA VIA STE 101
WALNUT CREEK CA
94598-3065
US

IV. Provider business mailing address

130 LA CASA VIA STE 101
WALNUT CREEK CA
94598-3065
US

V. Phone/Fax

Practice location:
  • Phone: 925-759-2319
  • Fax: 925-687-1990
Mailing address:
  • Phone: 925-759-2319
  • Fax: 925-687-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13669
License Number StateCA

VIII. Authorized Official

Name: MR. JACOB CHINN
Title or Position: OWNER/OPERATOR & QIGONG HEALER
Credential: L.AC, MSTCM, CMQ
Phone: 925-759-2319