Healthcare Provider Details

I. General information

NPI: 1629462601
Provider Name (Legal Business Name): CHNESE CLOVE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 CYPRESSWOOD DR
SPRING TX
77388-6038
US

IV. Provider business mailing address

153 CYPRESSWOOD DR
SPRING TX
77388-6038
US

V. Phone/Fax

Practice location:
  • Phone: 173-834-2946
  • Fax:
Mailing address:
  • Phone: 173-834-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMT121111
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberMT121111
License Number StateTX

VIII. Authorized Official

Name: MRS. PING CHEN
Title or Position: FOUNDER-MEMBER
Credential: LMT.
Phone: 713-834-2946