Healthcare Provider Details

I. General information

NPI: 1063185312
Provider Name (Legal Business Name): OKLAHOMA TCM CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 N MILITARY AVE STE 109
OKLAHOMA CITY OK
73106-5623
US

IV. Provider business mailing address

2524 N MILITARY AVE STE 109
OKLAHOMA CITY OK
73106-5623
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PING XIE
Title or Position: MANAGER
Credential:
Phone: 405-601-6077