Healthcare Provider Details

I. General information

NPI: 1417403031
Provider Name (Legal Business Name): SHANGHAI ACUPUNCTURE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 PIRKLE FERRY RD SUITE E
CUMMING GA
30040-9998
US

IV. Provider business mailing address

520 PIRKLE FERRY RD SUITE E
CUMMING GA
30040-9998
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-8896
  • Fax: 844-803-0063
Mailing address:
  • Phone: 404-402-9007
  • Fax: 844-803-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number14
License Number StateGA

VIII. Authorized Official

Name: MR. YUSHENG QIAO
Title or Position: OWNER
Credential: L. AC.
Phone: 404-402-9007