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General NPI Number Information
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NPI Number | 1194276436
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Entity Type | Organization
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Legal Business Name | PERSIMMON HEALTH CENTER, INC.
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1625 W MARCH LN
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City | STOCKTON
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State | CA
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Zip | 95207-6473
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Country | US
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Telephone | 209-955-0805
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Fax |
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Provider Business Mailing Address
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Address Line | 3845 PETERSBURG CIR
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City | STOCKTON
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State | CA
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Zip | 95219-3830
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Country | US
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Telephone | 209-955-0805
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Fax | 209-800-8823
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Authorized Official
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Title or Position | PRESIDENT, L.AC.
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Name | YONIE YOUNG
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Credential |
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Telephone | 209-955-0805
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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 | AC11287
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License Number State | CA
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