=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194559088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAVA ACUPUNCTURE INTEGRATIVE MEDICINE, PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2024
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 FOREST AVE STE 111
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-1422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-818-8004
-----------------------------------------------------
Fax | 408-400-3306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 FOREST AVE STE 111
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-1422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-818-8004
-----------------------------------------------------
Fax | 408-400-3306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LINH TAYLOR
-----------------------------------------------------
Credential | DTCM, LAC
-----------------------------------------------------
Telephone | 310-926-6106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------