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General NPI Number Information
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NPI Number | 1023322427
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Entity Type | Organization
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Legal Business Name | JING RIVER ACUPUNCTURE AND TRADITIONAL MEDICINE, LLC
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 925 HIGHWAY 55 SUITE 105
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City | HASTINGS
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State | MN
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Zip | 55033-3734
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Country | US
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Telephone | 651-674-3351
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Fax |
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Provider Business Mailing Address
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Address Line | 925 HIGHWAY 55 SUITE 105
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City | HASTINGS
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State | MN
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Zip | 55033-3734
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Country | US
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Telephone | 651-674-3351
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Fax |
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Authorized Official
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Title or Position | L.AC.
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Name | XIANGDONG YU
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Credential | PH.D
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Telephone | 651-674-3351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1406616
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License Number State | MN
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