Healthcare Provider Details

I. General information

NPI: 1780802231
Provider Name (Legal Business Name): SHUM'S ACUPUNCTURE CLINIC, CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2303
US

IV. Provider business mailing address

360 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2303
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-2228
  • Fax:
Mailing address:
  • Phone: 305-949-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1071
License Number StateFL

VIII. Authorized Official

Name: ELAINE CHAN
Title or Position: PRESIDENT
Credential:
Phone: 305-949-2228