Healthcare Provider Details

I. General information

NPI: 1568663664
Provider Name (Legal Business Name): PEI CHUN CHIN ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 98TH STREET CIR
BLOOMINGTON MN
55437-2146
US

IV. Provider business mailing address

4410 W 98TH STREET CIR
BLOOMINGTON MN
55437-2146
US

V. Phone/Fax

Practice location:
  • Phone: 942-941-4789
  • Fax:
Mailing address:
  • Phone: 942-941-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1252
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: