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General NPI Number Information
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NPI Number | 1104008531
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Entity Type | Organization
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Legal Business Name | SEQUOYAH ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 4400 KELLER AVE SUITE 250
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City | OAKLAND
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State | CA
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Zip | 94605-4281
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Country | US
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Telephone | 510-653-2964
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 KELLER AVE SUITE 250
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City | OAKLAND
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State | CA
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Zip | 94605-4281
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Country | US
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Telephone | 510-653-2964
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | SUNG HYUP KIM
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Credential | LA.C
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Telephone | 510-653-2964
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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 | 12081
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License Number State | CA
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