Healthcare Provider Details

I. General information

NPI: 1376911883
Provider Name (Legal Business Name): DANA ACUPUNCTURE CLINIC OF TAMPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7036 W HILLSBOROUGH AVE
TAMPA FL
33634-4948
US

IV. Provider business mailing address

7036 W HILLSBOROUGH AVE
TAMPA FL
33634-4948
US

V. Phone/Fax

Practice location:
  • Phone: 813-888-8070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2294
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA78935
License Number StateFL

VIII. Authorized Official

Name: HYE KIM
Title or Position: PRESIDENT
Credential:
Phone: 813-888-8070