Healthcare Provider Details

I. General information

NPI: 1801513379
Provider Name (Legal Business Name): SUNRISE ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 E 2700 S
SOUTH SALT LAKE UT
84115-3132
US

IV. Provider business mailing address

78 E 2700 S
SOUTH SALT LAKE UT
84115-3132
US

V. Phone/Fax

Practice location:
  • Phone: 801-696-5791
  • Fax:
Mailing address:
  • Phone: 801-355-8668
  • 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: TAO SUN
Title or Position: OWNER
Credential: MD
Phone: 801-355-8668