Healthcare Provider Details

I. General information

NPI: 1528237005
Provider Name (Legal Business Name): CHINA INSTITUTE OF TRADITIONAL CHINESE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 GRAND AVE
SAINT PAUL MN
55105-3019
US

IV. Provider business mailing address

1033 GRAND AVENUE
ST PAUL MN
55105
US

V. Phone/Fax

Practice location:
  • Phone: 651-222-1200
  • Fax:
Mailing address:
  • Phone: 651-222-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1072
License Number StateMN

VIII. Authorized Official

Name: DR. ZHUOLING REN
Title or Position: PRESIDENT
Credential:
Phone: 651-222-1200