Healthcare Provider Details

I. General information

NPI: 1598969107
Provider Name (Legal Business Name): CHINESE MEDICINE WELLNESS CENTER OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 LYNDON B JOHNSON FWY STE 230
DALLAS TX
75234-7670
US

IV. Provider business mailing address

4429 CALEDONIA CREEK LN
PLANO TX
75024-7047
US

V. Phone/Fax

Practice location:
  • Phone: 469-774-1688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number00574
License Number StateTX

VIII. Authorized Official

Name: YANHONG REN
Title or Position: VICE PRESIDENT
Credential:
Phone: 469-774-1688