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General NPI Number Information
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NPI Number | 1255407235
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR TRADITIONAL ACUPUNCTURE AND HERBOLOGY
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 21 TAMAL VISTA BLVD SUITE 110
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City | CORTE MADERA
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State | CA
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Zip | 94925-1130
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Country | US
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Telephone | 415-924-2910
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Fax | 415-924-5072
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Provider Business Mailing Address
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Address Line | 21 TAMAL VISTA BLVD SUITE 110
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City | CORTE MADERA
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State | CA
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Zip | 94925-1130
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Country | US
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Telephone | 415-924-2910
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Fax | 415-924-5072
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MIKI SHIMA
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Credential | N.D., O.M.D., L.AC.
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Telephone | 415-924-2910
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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 | AC 970
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 4943
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G62455
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 10122
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License Number State | CA
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