Healthcare Provider Details

I. General information

NPI: 1629134705
Provider Name (Legal Business Name): DIANA DAI ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NORTH ROAD SUITE 201
BEDFORD MA
01730
US

IV. Provider business mailing address

59 WOOD ST
LEXINGTON MA
02421-6415
US

V. Phone/Fax

Practice location:
  • Phone: 339-927-2342
  • Fax:
Mailing address:
  • Phone: 781-652-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number212023
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: