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General NPI Number Information
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NPI Number | 1245612357
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Entity Type | Organization
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Legal Business Name | FOUR CONNECTIONS ORIENTAL MEDICINE, INC
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 341 CASTRO ST STE D
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94041-1296
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Country | US
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Telephone | 408-660-5403
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Fax | 408-414-7732
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Provider Business Mailing Address
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Address Line | 341 CASTRO ST STE D
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94041-1296
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Country | US
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Telephone | 408-660-5403
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Fax | 408-414-7732
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Authorized Official
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Title or Position | CEO
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Name | MS. HUIBO CAROL CHEN
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Credential | L.AC
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Telephone | 408-660-5403
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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 | AC16506
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License Number State | CA
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