Healthcare Provider Details

I. General information

NPI: 1679958813
Provider Name (Legal Business Name): TAIJI ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 BLUEWING CT
FREDERICK MD
21703
US

IV. Provider business mailing address

1411 BLUEWING CT
FREDERICK MD
21703-5990
US

V. Phone/Fax

Practice location:
  • Phone: 240-439-1489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01871
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberUO1871
License Number StateMD

VIII. Authorized Official

Name: MR. YANGCHONG CHEN
Title or Position: OWNER
Credential:
Phone: 240-439-1489