=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104362490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MH WELLNESS & ACUPUNCTURE STUDIO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2017
-----------------------------------------------------
Last Update Date | 01/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11511 CANTERWOOD BLVD NW STE 40
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-632-0555
-----------------------------------------------------
Fax | 253-944-4074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7137 MONTEVISTA DR SE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98092-8224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-632-0555
-----------------------------------------------------
Fax | 253-944-4074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRACTITIONER
-----------------------------------------------------
Name | MR. HO YONG LIM
-----------------------------------------------------
Credential | EAMP, LAC, HERBALIST
-----------------------------------------------------
Telephone | 253-632-0555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC60695229
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------