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General NPI Number Information
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NPI Number | 1083968044
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Entity Type | Organization
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Legal Business Name | GRACE ACUPUNCTURE HEALTH CENTER INC.
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 2727 WALSH AVE SUITE 206
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City | SANTA CLARA
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State | CA
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Zip | 95051-0956
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Country | US
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Telephone | 408-748-1168
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 WALSH AVE., SUITE 206
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City | SANTA CLARA
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State | CA
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Zip | 95051
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Country | US
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Telephone | 408-748-1168
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Fax |
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Authorized Official
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Title or Position | MANAGER/ACUPUNCTURIST
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Name | MRS. YUN GONG
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Credential |
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Telephone | 408-529-3115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | AC12190
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License Number State | CA
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