Healthcare Provider Details

I. General information

NPI: 1023520665
Provider Name (Legal Business Name): ACA WA GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 SE 27TH ST, SUITE 103
MERCER ISLAND WA
98040
US

IV. Provider business mailing address

9001 SE 47TH ST
MERCER ISLAND WA
98040
US

V. Phone/Fax

Practice location:
  • Phone: 206-519-9039
  • Fax:
Mailing address:
  • Phone: 206-519-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60696857
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60654589
License Number StateWA

VIII. Authorized Official

Name: MR. HAIMING SHI
Title or Position: MANAGER
Credential: EAMP, LMP
Phone: 206-519-9039