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General NPI Number Information
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NPI Number | 1104206648
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Entity Type | Organization
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Legal Business Name | JADE TREE LLC
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Dates
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Enumeration Date | 05/29/2015
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 4690 NATOMAS BLVD STE 140
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City | SACRAMENTO
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State | CA
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Zip | 95835-2230
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Country | US
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Telephone | 530-979-6713
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 N PARK DR UNIT 3714
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City | SACRAMENTO
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State | CA
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Zip | 95835-1891
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Country | US
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Telephone | 916-833-2682
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEFAN CHENG
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Credential |
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Telephone | 530-979-6713
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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 | AC11935
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License Number State | CA
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