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General NPI Number Information
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NPI Number | 1053984898
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Entity Type | Organization
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Legal Business Name | SUN OVER MOUNTAIN ACUPUNCTURE INC.
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 201 MILLER AVE
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City | MILL VALLEY
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State | CA
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Zip | 94941-2817
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Country | US
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Telephone | 415-910-0685
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Fax |
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Provider Business Mailing Address
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Address Line | 201 MILLER AVE
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City | MILL VALLEY
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State | CA
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Zip | 94941-2817
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Country | US
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Telephone | 415-910-0685
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KYLE ROBERT HARTMAN
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Credential | LAC
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Telephone | 415-910-0685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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